Provider Enrollment Specialist

Description MDVIP: Transforming Primary Care, One Patient at a Time MDVIP is a national leader in personalized healthcare, empowering over 425,000 members to achieve their health and wellness goals through a network of more than 1,400 concierge primary care physicians. Our program emphasizes preventive medicine, offering comprehensive screenings, advanced diagnostics, an individualized wellness plans. Recognized as a Great Place to Work® since 2018, MDVIP is committed to excellence in patient care and employee satisfaction. Position Summary MDVIP is seeking a Provider Enrollment Manager reporting to the Associate Director of Insurance & Credentialing, to lead the insurance provider enrollment process for our MDVIP physician affiliates. This role requires deep expertise in credentialing and contracting, along with the ability to strategically guide physicians, practice staff, and internal stakeholders through complex enrollment requirements and scenarios. The Provider Enrollment Manager partners closely with internal leadership to manage high-impact, complex credentialing and enrollment matters, providing expert consultation that may influence national network participation strategy and operational performance. This role is accountable for analyzing and synthesizing critical, confidential data to develop executive-level reporting and insights that inform decision‑making. The ideal candidate is a strategic, solutions‑oriented leader with a strong track record in managing provider enrollment operations, driving process improvements, and navigating ambiguity in a highly regulated environment. Leading collaboration with the Insurance Services team to resolve complex, escalated enrollment and contracting issues. As the Provider Enrollment Manager, you’ll serve as a liaison between MDVIP and insurance carriers, commercial and federal clearinghouses, and regulatory bodies at the state, county, and federal levels. Additionally, you will ensure compliance with all licensing and credentialing requirements on behalf of MDVIP affiliated physicians. Key Responsibilities Credentialing & Contracting Coordination Leads and provides direction, coaching, and performance management for the Provider Enrollment team, ensuring strong execution, skill development, and accountability. Oversees team workflows, prioritization, and productivity to ensure all enrollment, credentialing, and contracting requirements are met timely and accurately. Manages complex, non‑standard enrollment and contracting scenarios, guiding resolution of exceptions, escalations, and payer‑specific requirements. Accountable for end‑to‑end enrollment and provider enrollment operations, ensuring compliance, data accuracy, and high‑quality service delivery. Serves as primary subject matter expert and liaison, driving alignment across physicians, internal stakeholders, payers, and external partners. Leads governance of provider enrollment data, ensuring integrity, reconciliation, and identification of risks impacting revenue, access, and compliance. Monitors program performance through reporting and analytics, identifying trends and driving continuous improvement. Evaluates payer participation strategies and physician‑specific needs, providing guidance on best practices, payer mix, timelines, and revenue impact. Oversees escalated and high‑priority cases, ensuring resolution aligns with compliance and organizational standards. Partners with Leadership and Legal to identify and mitigate contractual risks or conflicts. Ensures adherence to credentialing and contracting timelines, renewals through proactive management. Develops and delivers training, onboarding, and ongoing skill development for team members and stakeholders. Conducts research and resolves complex enrollment and credentialing issues with federal and commercial payers. Maintains subject matter expertise through ongoing education and awareness of industry trends. Complete statewide credentialing applications to establish new groups and add providers to commercial payers and Medicare Conducts detailed analysis and reconciliation of provider enrollment information across multiple systems proactively identifying discrepancies, downstream risks, and potential red flags. Provide training and guidance to affiliates, physician staff or respective billing companies related to MDVIP, when requested, on preventive billing protocols and/or provider enrollment needs. Represent the Provider Enrollment team during virtual and onsite corporate visits, serving as the subject matter expert, including Enrollment workflows, historical and regional performance metrics, and practice specific considerations to support physician onboarding during corporate visits. Manage complex and escalated provider enrollment cases, including high‑priority physicians payer‑specific expectations requiring advanced expertise, out of network scenarios, best practices, and reimbursement implications, ensuring alignment with organizational policy and compliance standards. Deliver new hire training for Provider Enrollment staff, ensuring team members receive comprehensive instruction on systems, workflows, payer requirements, and internal policies. Metrics & Reporting Oversees development, analysis, and distribution of provider enrollment status reports, ensuring accuracy, timeliness, and proactive follow‑up to drive issue resolution and case closure. Translates complex enrollment and contracting data into actionable insights, delivering reporting and presentations to support leadership decision making and operational planning. Escalation & Urgent Issues Leads analysis and reconciliation of provider enrollment data to ensure accuracy, compliance, and alignment with contracting requirements across complex workflows. Identifies and resolves escalated and high‑risk enrollment and contracting issues, providing root‑cause analysis, clear recommendations, and executive‑level visibility when needed. Requirements Key Competencies Demonstrated leadership experience managing provider enrollment or credentialing functions in a complex, matrixed environment. Strong analytical and critical thinking skills, with the ability to interpret complex data and translate findings into business insights. Effective relationship builder with physicians, staff, payers, and cross‑functional stakeholders. Clear, professional communicator with the ability to influence across diverse audiences. Proactive, solutions‑oriented leader who drives accountability, continuous improvement, and operational excellence. Strong organizational and execution skills, with a consistent focus on deadlines, accuracy, and outcomes. Strategic thinker with the ability to assess risk, identify trends, and inform decision‑making at the leadership level. Minimum Qualifications Associate’s degree and at least two (4) years related business experience Five (5) years of related work experience. Familiarity with EMR and credentialing software. Proficient in Microsoft Office applications. Preferred Qualifications Experience with CAQH, PECOS & NPPES applications. Experience with Net Docs, credentialing software, and athena. Certified Provider Credentialing Specialist (CPCS). Certified Provider Enrollment Specialist (CPES). Experience with Salesforce or other CRM tools. Why Join MDVIP? Be part of a mission‑driven organization leading innovation in personalized healthcare. Drive transformation and growth in a dynamic, fast‑paced environment. Competitive Compensation: Attractive base salary complemented by performance‑based incentives. Comprehensive Benefits: Health, dental, vision insurance, and retirement plans. Professional Development: Access to ongoing training and leadership development programs. Positive Work Environment: Consistently recognized as a Great Place to Work®, fostering a culture of collaboration and excellence. MDVIP is an Equal Opportunity Employer We welcome applicants of all backgrounds and do not discriminate based on race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected status. We believe that diversity and inclusion drive innovation and strengthen our company culture. If you require accommodations during the application or interview process, please let us know, and we will be happy to assist. #J-18808-Ljbffr