Provider Payer Enrollment Team Lead at Medic… · Beachwood

Description

Description:

The Provider Payer Enrollment Team Lead serves as a subject matter expert to the Provider Enrollment team in day-to-day provider enrollment operations. Helps support and guide accurate, timely payer enrollment and credentialing across Medicare, Medicaid, and commercial plans. This role leads training, coaching, workload management, and quality assurance functions to ensure compliance with payer and regulatory requirements, resolves complex enrollment issues, and partners with RCM leadership to drive performance, documentation standards, and continuous process improvement.

Responsibilities:

• Provide leadership, training, and ongoing oversight to payer enrollment team members to ensure compliance with established processes, procedures, and regulatory requirements.
• Serve as a subject matter expert, offering guidance and support related to provider enrollment workflows, payer requirements, and inventory management.
• Review and assign weekly workloads based on organizational priorities, ensuring balanced distribution of work and timely completion of tasks.
• Perform quality assurance reviews and audits of team output to ensure accuracy, consistency, adherence to defined standards and workflows, and reduce team errors and improve turnaround times.
• Support onboarding, training, coaching, and mentoring of new specialists, with an emphasis on department-specific and company-wide policies, procedures, and best practices.
• Collaborate with leadership to provide updates on departmental performance, including accomplishments, progress toward goals, risks, and challenges.
• Function as a key resource to enrollment specialists for issue resolution, complex cases, and process clarification.
• Assist with client-related inquiries as needed and contribute to the development and maintenance of training materials, enrollment policies, and procedural documentation.
• Complete and oversee administrative functions within the payer enrollment platform.
• Perform administrative functions such as approving timesheets for bi-weekly payroll, approving PTO requests, and contributing to performance feedback.
• Participate in internal team and external client meetings and help support administrative functions to prepare for meetings (i.e., agendas, reports, etc.)
• Will perform other functionally related duties as needed.

Requirements

Qualifications:

• High School Diploma or GED required. Associate or bachelor’s degree in healthcare administration, Business, or related field a plus.
• CPES through NAHCP, CPCS through NAMSS certifications are nice to have.
• 3-5 years of experience in provider enrollment/credentialing, with 2+ years of prior leadership, lead, or mentor role preferred.
• Strong working knowledge of Federally Qualified Health Center (FQHC), payer enrollment, and credentialing requirements and CAQH and Payer Portal workflows.
• Billing knowledge and experience preferred.
• Demonstrated in-depth understanding of payer enrollment processes, timelines, and compliance standards.
• Current knowledge of provider enrollment processes with Medicare, Medicaid, and commercial insurances in various states. 
• Proven ability to train, coach, and support team members while maintaining quality and productivity expectations.
• Strong organizational, communication, and critical thinking skills.
• Experience with Aria/CGM credentialing platform preferred.
• Proficient technical abilities with Microsoft products such as Outlook, Word, Excel, Teams, and Power Point.

Physical Demands:

· Work may require sitting for long periods of time. 

· Occasionally lifting files or paper. 

· Operating a computer, keyboard, telephone, copier, fax, scanner or other such office equipment through a normal business day. 

· Vision must be correctable to 20/20 for viewing information on computer screen and reading information in a paper format. 

· Hearing must be in the normal range for telephone contacts.

· Will require viewing computer screen and typing on a keyboard for prolonged periods of time.