Provider Enrollment Manager/Enrollment & Credentialing Leader

Job Title: Provider Enrollment Manager/Enrollment & Credentialing Leader

Location: Shelton, CT (Hybrid / Remote considered)

Employment Type: Full-Time

Job Summary

We are seeking an experienced Provider Enrollment Manager to manage end-to-end provider credentialing, payer enrollment, licensing, and operational delivery supporting Revenue Cycle Management (RCM) and ACO programs. This role will lead both onshore and offshore credentialing teams, drive operational excellence, ensure compliance with payer/CMS requirements, and oversee KPI reporting, analytics, and client communication.

The ideal candidate will bring strong leadership experience in healthcare credentialing operations, payer enrollment workflows, provider onboarding, and distributed team management.

Key ResponsibilitiesProvider Enrollment & Credentialing Operations

• Lead provider credentialing, enrollment, re-credentialing, and payer enrollment activities
• Ensure compliance with CMS, payer, licensing board, and regulatory requirements
• Manage provider onboarding, revalidation, group additions/removals, and attestations
• Maintain accurate credentialing records and verification documentation
• Coordinate with internal stakeholders to meet provider start dates and enrollment timelines

Offshore Team & Operational Leadership

• Manage distributed/onshore-offshore credentialing teams
• Ensure SLA adherence, productivity, quality, and operational efficiency
• Conduct coaching, performance reviews, and staff development
• Support workforce planning and resource allocation based on business demand
• Coordinate workflows across multiple time zones

Analytics, Reporting & KPI Management

• Monitor credentialing turnaround times, enrollment completion rates, and productivity metrics
• Build and maintain operational dashboards and KPI reports
• Identify process gaps and implement continuous improvement initiatives
• Deliver weekly/monthly operational reports to leadership
• Support month-end billing validation and operational cost management

Client & Stakeholder Management

• Act as a client-facing lead for credentialing and enrollment operations
• Maintain relationships with payers, health plans, MCOs, and licensing boards
• Collaborate with sales, customer success, and operations teams
• Participate in client meetings and provide operational updates and credentialing expertise

Required Qualifications

• Bachelor s degree in Healthcare Administration, Business, or related field
• 5 8+ years of experience in provider credentialing, enrollment, or healthcare operations
• 3+ years of leadership experience managing credentialing teams
• Strong knowledge of payer enrollment workflows, CMS regulations, and provider licensing
• Experience supporting RCM and/or ACO environments
• Experience managing offshore/global delivery teams preferred
• Credentialing certification is a plus

Required Skills

• Provider Credentialing & Enrollment
• Payer Enrollment & Licensing
• CMS & Regulatory Compliance
• Revenue Cycle Management (RCM)
• ACO Credentialing Operations
• KPI Reporting & Analytics
• SLA Management
• Offshore Team Leadership
• Client Relationship Management
• Operational Reporting & Process Improvement

Preferred Experience

• Healthcare services / managed care environment
• Multi-client credentialing operations
• Distributed team management
• Credentialing audit readiness and compliance tracking

Soft Skills

• Strong communication and stakeholder management
• Analytical and detail-oriented mindset
• Ability to prioritize multiple projects in a fast-paced environment
• Strong leadership and team collaboration skills

Industry: Healthcare / Revenue Cycle Management / Provider Operations