Manager, Provider Enrollment

About This Role

Managing the insurance provider enrollment process for MDVIP physician affiliates is the core of this role, reporting to the Associate Director of Insurance & Credentialing. This position requires deep expertise in credentialing and contracting, with the ability to strategically guide physicians, practice staff, and internal stakeholders through complex enrollment requirements. The manager partners with internal leadership on high-impact credentialing and enrollment matters, providing expert consultation that may influence national network participation strategy and operational performance.

Responsibilities

• Lead and provide direction, coaching, and performance management for the Provider Enrollment team, ensuring strong execution, skill development, and accountability
• Oversee team workflows, prioritization, and productivity to ensure all enrollment, credentialing, and contracting requirements are met timely and accurately
• Manage complex, non-standard enrollment and contracting scenarios, guiding resolution of exceptions, escalations, and payer-specific requirements
• Account for end-to-end enrollment and provider enrollment operations, ensuring compliance, data accuracy, and high-quality service delivery
• Serve as primary subject matter expert and liaison, driving alignment across physicians, internal stakeholders, payers, and external partners
• Lead governance of provider enrollment data, ensuring integrity, reconciliation, and identification of risks impacting revenue, access, and compliance
• Monitor program performance through reporting and analytics, identifying trends and driving continuous improvement
• Evaluate payer participation strategies and physician-specific needs, providing guidance on best practices, payer mix, timelines, and revenue impact
• Oversee escalated and high-priority cases, ensuring resolution aligns with compliance and organizational standards
• Partner with Leadership and Legal to identify and mitigate contractual risks or conflicts
• Ensure adherence to credentialing and contracting timelines, renewals through proactive management
• Develop and deliver training, onboarding, and ongoing skill development for team members and stakeholders
• Conduct research and resolve complex enrollment and credentialing issues with federal and commercial payers
• Maintain subject matter expertise through ongoing education and awareness of industry trends
• Complete statewide credentialing applications to establish new groups and add providers to commercial payers and Medicare
• Conduct detailed analysis and reconciliation of provider enrollment information across multiple systems proactively identifying discrepancies, downstream risks, and potential red flags
• Provide training and guidance to affiliates, physician staff or respective billing companies related to MDVIP, when requested, on preventive billing protocols and/or provider enrollment needs
• Represent the Provider Enrollment team during virtual and onsite corporate visits, serving as the subject matter expert, including Enrollment workflows, historical and regional performance metrics, and practice specific considerations to support physician onboarding during corporate visits
• Manage complex and escalated provider enrollment cases, including high-priority physicians payer-specific expectations requiring advanced expertise, out of network scenarios, best practices, and reimbursement implications, ensuring alignment with organizational policy and compliance standards
• Deliver new hire training for Provider Enrollment staff, ensuring team members receive comprehensive instruction on systems, workflows, payer requirements, and internal policies
• Oversee development, analysis, and distribution of provider enrollment status reports, ensuring accuracy, timeliness, and proactive follow-up to drive issue resolution and case closure
• Translate complex enrollment and contracting data into actionable insights, delivering reporting and presentations to support leadership decision making and operational planning
• Lead analysis and reconciliation of provider enrollment data to ensure accuracy, compliance, and alignment with contracting requirements across complex workflows
• Identify and resolve escalated and high-risk enrollment and contracting issues, providing root-cause analysis, clear recommendations, and executive-level visibility when needed

Requirements

• Demonstrated leadership experience managing provider enrollment or credentialing functions in a complex, matrixed environment
• Strong analytical and critical thinking skills, with the ability to interpret complex data and translate findings into business insights
• Effective relationship builder with physicians, staff, payers, and cross-functional stakeholders
• Clear, professional communicator with the ability to influence across diverse audiences
• Proactive, solutions-oriented leader who drives accountability, continuous improvement, and operational excellence
• Strong organizational and execution skills, with a consistent focus on deadlines, accuracy, and outcomes
• Strategic thinker with the ability to assess risk, identify trends, and inform decision-making at the leadership level
• Associate
• Five years of related work experience
• Familiarity with EMR and credentialing software
• Proficient in Microsoft Office applications

Nice to have:

• Experience with CAQH, PECOS & NPPES applications
• Experience with Net Docs, credentialing software, and athena
• Certified Provider Credentialing Specialist (CPCS)
• Certified Provider Enrollment Specialist (CPES)
• Experience with Salesforce or other CRM tools

Benefits

• Annual incentive compensation programs, subject to applicable eligibility requirements
• Medical/prescription drug coverage
• Dental coverage
• Vision coverage
• Flexible Spending Account
• Health Savings Account
• Dependent Care Flexible Spending Account
• Basic and Supplemental Life Insurance & Accidental Death and Dismemberment
• Disability Income Protection Plan
• Employee Assistance Program
• 401(k) retirement program
• Vacation
• Paid Holidays and Personal time
• Paid Sick and Family and Medical Leave time as required by law
• Professional Development: Access to ongoing training and leadership development programs
• Positive Work Environment: Consistently recognized as a Great Place to Work

About the Company

MDVIP is a national leader in personalized healthcare, empowering over 425,000 members to achieve their health and wellness goals through a network of more than 1,400 concierge primary care physicians. The program emphasizes preventive medicine, offering comprehensive screenings, advanced diagnostics, and individualized wellness plans. Recognized as a Great Place to Work since 2018, MDVIP is committed to excellence in patient care and employee satisfaction.