Job Description
Position Summary
The Director of Provider Enrollment provides strategic and operational leadership for provider and facility enrollment across Boston Children’s Hospital, the Physicians’ Organization and its related foundations, and Franciscan Children’s Hospital. Reporting to the Senior Director, Professional Medical Staff Services, the Director oversees contracted, government, and out-of-state Medicaid enrollment for all billable providers and entities, ensuring compliance with applicable regulatory, state, and federal requirements. The Director leads a team responsible for timely, accurate, and comprehensive enrollment and develops strategies to improve efficiency, quality, and outcomes through data, technology, and continuous process improvement. This role will partner with senior leaders across Revenue Cycle, Patient Financial Services, Government Relations, Payer Relations, Medical Staff Services, and other areas to advance enterprise-wide initiatives and ensure effective provider enrollment processes.
Key Responsibilities
Required Qualifications
The Director of Provider Enrollment provides strategic and operational leadership for provider and facility enrollment across Boston Children’s Hospital, the Physicians’ Organization and its related foundations, and Franciscan Children’s Hospital. Reporting to the Senior Director, Professional Medical Staff Services, the Director oversees contracted, government, and out-of-state Medicaid enrollment for all billable providers and entities, ensuring compliance with applicable regulatory, state, and federal requirements. The Director leads a team responsible for timely, accurate, and comprehensive enrollment and develops strategies to improve efficiency, quality, and outcomes through data, technology, and continuous process improvement. This role will partner with senior leaders across Revenue Cycle, Patient Financial Services, Government Relations, Payer Relations, Medical Staff Services, and other areas to advance enterprise-wide initiatives and ensure effective provider enrollment processes.
Key Responsibilities
- Provides strategic direction and operational oversight for provider and facility enrollment across the enterprise.
- Oversees contracted payer, government, and out-of-state Medicaid enrollment activities, ensuring timely, accurate, and compliant submissions.
- Leads and develops the Provider Enrollment team, including managers and staff; establishes priorities, delegates effectively, develops talent, and fosters accountability and continuous improvement.
- Uses data, analytics, and performance metrics to identify opportunities, evaluate outcomes, and drive process improvements across provider enrollment functions.
- Leads strategic and tactical projects with enterprise-wide impact, managing multiple initiatives, timelines, resources, and stakeholder needs.
- Partners with PO Billing, Patient Financial Services, Government Relations, Payer Relations, Medical Staff Services, and other clinical and administrative leaders to improve enrollment processes and outcomes.
- Identifies opportunities to leverage technology and develop efficient, scalable models for provider enrollment across multiple entities.
- Develops, maintains, and implements policies, procedures, and governance related to provider enrollment.
- Oversees the Provider Enrollment budget and collaborates with leadership on staffing, resources, and strategic priorities.
- Collaborates with the Sr. Director, Medical Staff Services, to identify opportunities for process integration and improvement across related functions.
- Serves as a strategic partner to senior leaders, using sound judgment, analytical expertise, and cross-functional influence to address complex issues and support decision-making.
Required Qualifications
- Bachelor’s degree required; Master’s degree in Healthcare Administration or related field preferred.
- Minimum of 8 years of related experience, including 5 years of progressive management experience.
- Strong working knowledge of provider enrollment principles, processes, and applicable regulatory requirements.
- Demonstrated experience leading provider enrollment operations within a complex healthcare organization or multi-entity environment.
- Strong project management and organizational skills, with the ability to manage multiple priorities and enterprise-wide initiatives simultaneously.
- Demonstrated ability to use data and analytics to identify opportunities, solve complex problems, and drive process improvement.
- Strong leadership, communication, relationship-building, and influencing skills, with the ability to effectively engage senior leaders and diverse stakeholders.
- Demonstrated ability to navigate ambiguity, exercise sound judgment, set priorities, and make timely decisions.
- Ability to manage complex relationships with composure, interpersonal savvy, and strong listening skills.
- Certified Provider Enrollment Specialist (CPES) preferred.
Numbers & Facts
| Location | Boston, MA |
Skills
- Analysis Skillsunmatched
- Budgetingunmatched
- Channel Strategiesunmatched
- Communication Skillsunmatched
- Continuous Improvementunmatched
- Cross-Functionalunmatched
- Data Analysisunmatched
- Decision Supportunmatched
- Establish Prioritiesunmatched
- Federal Laws and Regulationsunmatched
- Financial Servicesunmatched
- Government Contractsunmatched
- Government Relationsunmatched
- Healthcareunmatched
- Healthcare Administrationunmatched
- Hospitalunmatched
- Interpersonal Skillsunmatched
- Leadershipunmatched
- Maintain Complianceunmatched
- Medicaidunmatched
- Medical Billingunmatched
- Multitaskingunmatched
- Operational Strategyunmatched
- Organizational Skillsunmatched
- Performance Metricsunmatched
- Policy Implementationunmatched
- Problem Solving Skillsunmatched
- Procedure Implementationunmatched
- Process Improvementunmatched
- Professional Servicesunmatched
- Project/Program Managementunmatched
- Quality Managementunmatched
- Regulatory Complianceunmatched
- Regulatory Requirementsunmatched
- Relationship Managementunmatched
- Scalable System Developmentunmatched
- State Laws and Regulationsunmatched
- Strategic Planningunmatched
- Talent Managementunmatched
- Team Lead/Managerunmatched
- Time Managementunmatched
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