Lead, Provider Enrollment

Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia emergency medicine hospital medicine pathology and radiology. Focused on Revenue Cycle Management Ventra partners with private practices hospitals health systems and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues enabling clinicians to focus on providing outstanding care to their patients and communities.

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• The Team Lead Provider Enrollment plays a key leadership role in the Provider Enrollment department acting as a mentor subject matter expert and operational resource for a team of enrollment specialists. This role supports the Supervisor and Manager by overseeing daily workflows resolving escalated issues and ensuring enrollment tasks are completed accurately and in a timely manner. The Team Lead works collaboratively across internal teams and with external payers to support efficient provider onboarding and compliance with payer requirements.

• Lead mentor and support a team of Provider Enrollment Specialists in their daily tasks and development.
• Assist with onboarding and training new team members; develop and maintain training materials and SOPs.
• Monitor daily workload queues to ensure timely completion of enrollment tasks and proper case prioritization.
• Serve as the first point of escalation for complex enrollment issues or payer communication delays.
• Perform advanced follow-up with CMS Medicaid and third-party payers to resolve issues and ensure timely application processing.
• Ensure the accurate submission tracking and follow-up of CMS Medicare State Medicaid and commercial payer applications.
• Audit provider enrollment records and documentation to ensure compliance with internal standards and external payer requirements.
• Partner with clients market locations operations personnel and revenue cycle stakeholders to facilitate smooth provider onboarding and ongoing maintenance.
• Proactively manage payer revalidation schedules and ensure timely renewals to prevent lapses in enrollment or deactivation.
• Track and maintain documentation of enrollment activities in all applicable systems.
• Maintain up-to-date knowledge of payer rules credentialing requirements and regulatory changes impacting provider enrollment.
• Contribute to process improvement initiatives and help drive efficiency across the team.
• Perform special projects and other duties as assigned.

• High School diploma or equivalent.
• 2 years of experience in provider enrollment credentialing or payer relations within a healthcare or RCM environment.
• 1 year of experience in a lead or supervisory role preferred.

• In-depth knowledge of CMS State Medicaid and commercial payer application requirements.
• Strong understanding of DEA CV NPI CAQH and other credentialing components.
• Working knowledge of HIPAA Privacy & Security policies.
• Exceptional oral and written communication skills.
• Proficiency in Microsoft Office Suite (Excel Word Outlook) and credentialing software tools.
• Strong problem-solving organizational and analytical skills.
• Ability to balance multiple priorities meet deadlines and adapt to changing workflows.
• High attention to detail and commitment to accuracy.
• Collaborative team-oriented mindset with a professional and tactful demeanor.
• Self-starter who can work independently while contributing to team goals.
• Ability to maintain strict confidentiality of sensitive provider and organizational data.
• Ability to ensure the complex enrollment packages are complete and correct.
• Ability to work cohesively in a team-oriented environment.
• Ability to foster good working relationships with others both within and outside the organization.
• Ability to work independently and require little supervision to focus on and accomplish tasks.
• Ability to maintain strict confidentiality with regards to protected provider and health information.
• Ability to take initiative and effectively troubleshoot while focusing on innovative solutions.
• Ability to exercise sound judgment and handle highly sensitive and confidential information appropriately.
• Ability to remain flexible and work within a collaborative and fast paced environment.
• Ability to communicate with diverse personalities in a tactful mature and professional manner.

• Base Compensation will be based on various factors unique to each candidate including geographic location skill set experience qualifications and other job-related reasons.

• This position is also eligible for a discretionary incentive bonus in accordance with company policies.

Equal Employment Opportunity (Applicable only in the US)
Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates and all qualified applicants will receive consideration for employment without regard to race color ethnicity religion sex age national origin disability sexual orientation gender identity and expression or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities as needed to assist them in performing essential job functions.

Recruitment Agencies
Ventra Health does not accept unsolicited agency resumes. Ventra Health is not responsible for any fees related to unsolicited resumes.

Solicitation of Payment
Ventra Health does not solicit payment from our applicants and candidates for consideration or placement.

Attention Candidates
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