Director of Payer Enrollment

The Role

The Director of Payer Enrollment provides strategic leadership for the full payer enrollment team, including commercial enrollment, government enrollment (with the Government PE Manager), and contracting. This leader owns payer enrollment metrics across the team, with clear accountability for turnaround, quality, and rework. The Director brings an executive-level presence to customer relationships, leading enrollment strategy for strategic customers and partnering closely with Operations, Sales, Customer Success, Product Development, and Leadership.

What You'll Do

• Own turnaround, quality, and rework across the full payer enrollment team (commercial, government, and contracting).

• Oversee the Contracting team, ensuring the timely implementation and receipt of customer health plan contracts, process reviews, and consistent, timely communication with customers.

• Develop and implement strategies and workflows to reduce enrollment cycle time and minimize delays in reimbursement.

• Establish and maintain strong relationships with commercial and government payers.

• Ensure compliance with all applicable regulations, accreditation standards, and payer-specific requirements.

• Track key performance indicators (KPIs) for turnaround, quality, rework, denial rates, and provider participation.

• Collaborate with Credentialing, Licensing,Sales, Customer Success, and Product Development teams.

• Own the payer enrollment tooling and systems strategy (such as Availity, CAQH, PECOS, CMS I&A, and NPPES), with the team operating these systems day to day.

• Set the SOP template and quality bar, prioritize customer SOPs, and maintain a North Star enrollment strategy for each customer.

• Build a unified QA and SLA view across customers.

• Identify areas for process improvement and lead initiatives to optimize payer enrollment operations.

• Prepare and present regular reports to executive leadership on enrollment status, trends, and challenges.

• Serve as a subject matter expert on enrollment policies and regulations (Medicare, Medicaid, and commercial payers).

• Lead pre-contract discovery and executive customer strategy, including enrollment strategy for strategic customers and handling tough escalations.

• Build the payer enrollment team structure, roles, training, and SME team.
  

What We're Looking For

Qualifications

• Track record scaling payer enrollment or operations at a large provider organization, ideally at PE-backed provider groups or scaled digital health or health tech companies.

• Experience leading managers and multi-function teams.

• Executive-facing customer experience.

• Deep understanding of provider enrollment processes and regulations.

• Familiarity with CAQH, PECOS, NPPES, and commercial payer systems.

• Strong project management, analytical, and problem-solving skills.

• Excellent verbal and written communication.

• Ability to manage multiple priorities and deadlines.

• Proficiency in healthcare software systems and Microsoft Office Suite.

• Customer escalation handling and executive presence.

• A clear management philosophy and approach to team organization.

• Building and refining SOPs and quality bars.

• Customer enrollment strategy.

• Metrics-driven management using data or BI tools.

Nice To have

• Experience with automation or AI agents, including knowing when not to use them.