About This Role
This role oversees provider and facility enrollment activities across the Boston Children
Responsibilities
- Manage provider and facility enrollment across Boston Children
- Oversee enrollment with contracted insurance plans, out-of-state Medicaid programs, and out-of-state licensing authorities
- Manage delegated relationships with insurance plans, including contract review and compliance with National Committee for Quality Assurance (NCQA) standards and applicable state and federal regulations
- Collaborate with clinical and administrative leaders to identify opportunities for process improvement, strengthen enrollment operations, and support quality and performance initiatives
- Lead the Provider Enrollment Team, including hiring, training, staff development, performance management, and workforce planning
- Monitor staffing levels and recommend adjustments to maintain operational effectiveness and compliance with organizational standards
- Develop and present educational materials and informational sessions on provider enrollment processes and requirements to support enterprise-wide reimbursement strategies
- Manage the Provider Enrollment Team budget in collaboration with the Physicians
Requirements
- Associate
- Minimum of 3 years of related provider enrollment experience
- Knowledge of applicable state and federal laws and regulations governing hospitals, providers, and billing practices
- Familiarity with Massachusetts insurance market
- Working knowledge of provider and facility enrollment requirements, hospital bylaws, insurance contracts, and applicable regulatory standards
- Team management experience and the ability to lead, develop, and motivate staff while managing departmental priorities and performance
- Strong attention to detail, ensuring accuracy, completeness, and compliance across complex enrollment processes
- Analytical and problem-solving skills, with the ability to identify issues, evaluate options, and implement effective solutions
- Strong written and verbal communication skills, with the ability to work effectively with diverse internal and external stakeholders
- Ability to influence and negotiate with senior leaders and managers on matters affecting multiple departments
- Strong project management, organizational, and time management skills, with the ability to manage competing priorities and deadlines
- Advanced proficiency with computer systems and software used in provider and facility enrollment operations
Benefits
- Flexible schedules
- Affordable health, vision and dental insurance
- Child care and student loan subsidies
