Director of Provider Enrollment

Starting Salary Range: $65,000-$70,000

FLSA Status: Exempt

Employment Status/Hours: Full time, 35 hours per week

SUMMARY OF DUTIES

The Director of Provider Enrollment is responsible for leading the operational leadership for the BestSelf's provider enrollment and facility enrollment processes. This role will be responsible for ensuring the timely, accurate, and compliant enrollment, revalidation, maintenance, and updates to provider information across applicable commercial and government insurance programs. The Director of Provider Enrollment will establish, maintain, and oversee standardized processes, internal controls, and accountability to maintain seamless provider eligibility and billing readiness, minimize enrollment related revenue disruptions, and ensure compliance with applicable federal & state regulations, payer requirements, and organizational policies. The Director of Provider Enrollment will partner with various internal team members to align provider enrollment activities with operational needs and strategic objectives, while maintaining a positive employee experience.

LEADERSHIP RESPONSIBILITIES

• This position holds overarching responsibility for the strategic leadership and operational oversight of the Provider Enrollment area of Human Resources. In addition to managing day-to-day operations, the role entails driving the professional growth and success of direct reports through continuous coaching, actionable feedback, and targeted development initiatives. This role will also foster a culture of accountability, collaboration, and high performance, ensuring that all direct reports are equipped to excel in their roles and contribute meaningfully to the organization's long-term success that align with both team and organizational goals.

RESPONSIBILITIES

Provider & Facility Enrollment

• Oversee all Provider Enrollment activities to ensure all providers are appropriately enrolled, affiliated, and eligible to render services in a timely manner including but not limited to: initial enrollment, revalidation, CAQH maintenance, renewals, demographic updates, location changes, affiliation changes, and other applicable provider updates across all payers and programs for BestSelf.
• Oversee Facility Enrollment and re-enrollment activities for all of BestSelf and its programs/locations.
• Monitor enrollment statuses, application processing, approval timeliness, expirations, and outstanding requirements.
• Collaborate with internal leadership to identify & address enrollment denials and/or barriers and support organizational initiatives.

Compliance, Systems, and Operational Excellence

• Ensure provider enrollment activities comply with applicable federal and state regulations, payer requirements, contractual obligations, and organization policies at all times.
• Develop and maintain internal controls that will identify opportunities to improve such as but not limited to process automation, billing readiness, enrollment gaps or barriers, expired approvals, missing documentation, record/data discrepancies that may effect compliance or reimbursement, etc.
• Monitor regulatory and payer policy changes and translate new requirements into operational procedures, trainings, and/or controls.
• Establish and maintain centralized tracking mechanisms for enrollment status, revalidation deadlines, outstanding applications, expirations, and identified risks.
• Provide leadership with timely updates on enrollment statistics, risks, operational barriers, and corrective action plans.
• Develop and maintain training materials, standards, procedures, workflows, and reference resources for Provider Enrollment team and relevant internal partners.
• Develop and maintain the annual Provider Enrollment deadline & communication schedule of duties.
• Ensure strict confidentiality in all methods of team and individual work & communication.
• Present on Provider Enrollment and other HR related topics as needed.
• Travel as needed to attend meetings, give presentations, or support department-specific events.
• Completes all trainings required by the agency.
• Performs all other duties as assigned.

QUALIFICATIONS

• At least 3 years of Provider & Facility Enrollment experience in behavioral health and healthcare settings. Experience in non-profit organizations preferred.
• Extensive knowledge of all local, state, and federal payer, provider, & facility enrollment and regulatory guidelines.
• Strong strategic thinking and leadership capabilities in a fast-paced environment.
• Experience using Provider Enrollment specific tracking systems preferred.
• Advanced knowledge of Microsoft Excel. Experience with PowerBI or other reporting/KPI monitoring tools strongly preferred.
• Excellent communication and interpersonal skills, with the ability to influence at all levels.
• Must be comfortable presenting to all audience levels and group settings.
• High level of professionalism, judgment, and problem-solving ability.
• Strong analytical skills and attention to detail.
• Ability to travel as requested.

BestSelf Behavioral Health considers all applicants for all positions without regard to race, religion, creed, gender, national origin, age, disability , marital or veteran status, sexual orientation, or any other legally-protected status.  Please note, applicants must be legally authorized to work in the United States. The agency is unable to provide visa sponsorship or work authorization for this position.