Provider Enrollment Manager

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Children's Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20,000 Breakthrough Makers will inspire you to pursue passions, develop expertise, and drive innovation.

At CHOP, your experience is valued; your voice is heard; and your contributions make a difference for patients and families. Join us as we build on our promise to advance pediatric care-and your career.

CHOP does not discriminate on the basis of race, color, sex, national origin, religion, or any other legally protected categories in any employment, training, or vendor decisions or programs. CHOP recognizes the critical importance of a workforce rich in varied backgrounds and experiences and engages in ongoing efforts to achieve that through equally varied and non-discriminatory means.

A Brief Overview
This Enrollment Manager serves as an operational leader and subject matter expert in revenue cycle management and accounts receivable operations. Key responsibilities of the role include building an outstanding team culture through consistent engagement; fostering professional development of all direct and indirect reports, especially the next generation of CHOP leaders; identifying, deploying, and maintaining best practices in revenue cycle operations; understanding and monitoring Key Performance Indicators (KPIs), and taking quick and appropriate action to maintain the financial health of CHOPPA.

The Provider Enrollment Manager is responsible for overseeing the day-to-day operations of provider enrollment activities, ensuring timely and accurate enrollment, revalidation, and maintenance of provider records across all payers. This role leads a team of enrollment professionals, drives operational efficiency, and supports revenue cycle performance through effective enrollment processes.

The Manager partners cross-functionally with internal stakeholders, including clinical and revenue cycle teams, and serves as a key escalation point for complex enrollment issues. This role also supports workflow optimization within Credentialing systems (e.g. CredentialStream) and leverages reporting insights to improve performance, while maintaining a strong focus on team leadership, process consistency, and service excellence.

What you will do

Team Leadership & Oversight

• Lead, coach, and develop a team of Provider Enrollment Coordinators and/or Specialists
• Recruit, train, mentor, and evaluate staff to ensure high performance and professional development.
• Establish clear performance expectations, productivity standards, and accountability measures.
• Conduct regular team meetings, one-on-ones, and performance evaluations.
• Support onboarding and training of new team members
• Foster a culture of accuracy, urgency, collaboration, and continuous improvement.

Enrollment Operations & Workflow Management

• Oversee the full lifecycle of provider enrollment, including: initial enrollment, revalidation and recredentialing, updates, and terminations.
• Ensure timely submission, tracking, and follow-up of all enrollment applications.
• Monitor work queues and ensure appropriate prioritization of tasks

Workflow Optimization & Process Improvement

• Identify inefficiencies in enrollment workflows and implement process improvements
• Standardize procedures to ensure consistency across the team
• Partner with leadership on larger process improvement initiatives
• Support system enhancements and workflow optimization efforts

Regulatory Compliance & Data Integrity

• Ensure provider enrollment activities comply with all applicable federal, state, and payer-specific requirements
• Maintain current knowledge of payer enrollment rules, regulatory updates, and industry best practices.
• Partner with Compliance and Credentialing teams to support audit readiness and regulatory inquiries
• Ensure accuracy and integrity of provider enrollment data across systems
• Monitor and address compliance-related risks within enrollment workflows

Performance Monitoring & Reporting

• Track and monitor key performance indicators such as enrollment turnaround times and application aging
• Provide regular reporting and insights to leadership
• Identify trends and implement corrective actions to improve performance.

Issue Resolution & Escalation Management

• Serve as the primary escalation point for complex enrollment issues and payer-related challenges
• Partner with internal stakeholders to resolve delays, denials, and discrepancies
• Maintain strong relationships with payer representatives to facilitate issue resolution.

Cross-Functional Collaboration

• Collaborate with Credentialing, Medical Staff Services, Billing, and Operations teams
• Support provider onboarding and readiness for billing
• Participate in organizational initiatives related to enrollment and revenue cycle operations

Education Qualifications

• High School Diploma / GED Required
• Bachelor's Degree Preferred

Experience Qualifications

• At least five (5) years experience in provider enrollment and/or credentialing with large healthcare organizations, Medicare and Medicaid Required and
• At least three (3) years leadership or supervisory or leadership role within a healthcare environment Required

Skills and Abilities

• Strong knowledge of: CMS (Medicare/Medicaid) enrollment processes; Commercial payer enrollment requirements; CAQH, PECOS, NPPES, and payer portals (e.g., Availity) (Required proficiency)
• Understanding of revenue cycle workflows and financial impact of enrollment delays (Required proficiency)
• Excellent leadership, coaching, and team development skills (Required proficiency)
• Strong analytical and problem-solving abilities (Required proficiency)
• Advanced organizational and time management skills (Required proficiency)
• High attention to detail and commitment to data accuracy (Required proficiency)
• Strong communication and interpersonal skills, with ability to work cross functionally (Required proficiency)
• Knowledge of HIPAA and data privacy requirements (Required proficiency)

To carry out its mission, CHOP is committed to supporting the health of our patients, families, workforce, and global community. As a condition of employment, CHOP employees who work in patient care buildings or who have patient facing responsibilities must receive an annual influenza vaccine. Learn more.

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SALARY RANGE:

Salary ranges are shown for full-time jobs. If you're working part-time, your pay will be adjusted accordingly.

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At CHOP, we are committed to fair and transparent pay practices. Factors such as skills and experience could result in an offer above the salary range noted in this job posting. Click here for more information regarding CHOP's Compensation and Benefits.