Job Description
Position Summary
The Manager, Provider Enrollment oversees provider and facility enrollment activities across the Boston Children’s Hospital enterprise, including the Physicians’ Organization and Franciscan Children’s Hospital. Reporting to the Director of Provider Enrollment, this role ensures timely, accurate, and compliant enrollment with contracted insurance plans, out-of-state Medicaid programs, and applicable state licensing authorities. The Manager leads the Provider Enrollment Team, manages delegated relationships with insurance plans, and collaborates with clinical and administrative leaders to support operational efficiency, regulatory compliance, and reimbursement objectives.
Key Responsibilities
The Manager, Provider Enrollment oversees provider and facility enrollment activities across the Boston Children’s Hospital enterprise, including the Physicians’ Organization and Franciscan Children’s Hospital. Reporting to the Director of Provider Enrollment, this role ensures timely, accurate, and compliant enrollment with contracted insurance plans, out-of-state Medicaid programs, and applicable state licensing authorities. The Manager leads the Provider Enrollment Team, manages delegated relationships with insurance plans, and collaborates with clinical and administrative leaders to support operational efficiency, regulatory compliance, and reimbursement objectives.
Key Responsibilities
- Manage provider and facility enrollment across Boston Children’s Hospital, the Physicians’ Organization and its related foundations, and Franciscan Children’s Hospital, ensuring timely and accurate enrollment in accordance with contractual and regulatory requirements.
- 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’ Organization and partner with the Director to identify operational and strategic priorities.
- Associate’s degree required; Bachelor’s degree preferred.
- 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.
Numbers & Facts
| Location | Boston, MA |
Skills
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