Manager, Provider Enrollment & Managed Care Ops. Financial Admin, Full Time, Day
Valley Health System
Summary
The Manager, Provider Enrollment and Managed Care Operations is responsible for the operational management, oversight and performance of Valley Health System's payer relations, provider enrollment and delegated credentialing functions. The position translates the organization's managed care strategy and contractual requirements into operational processes, establishes performance standards and ensures that payer, provider enrollment and delegated credentialing activities are executed accurately, timely and in compliance with applicable payer and regulatory requirements.
Job description
Position Summary
The Manager, Provider Enrollment and Managed Care Operations is responsible for the operational management, oversight and performance of Valley Health System's payer relations, provider enrollment and delegated credentialing functions. The position translates the organization's managed care strategy and contractual requirements into operational processes, establishes performance standards and ensures that payer, provider enrollment and delegated credentialing activities are executed accurately, timely and in compliance with applicable payer and regulatory requirements.
This position provides direct leadership and oversight to the provider enrollment team, ensuring timely and accurate enrollment of providers with payers, maintenance of enrollment records, and resolution of enrollment-related issues. Position serves as internal owner of delegated credentialing matters and ensures that Valley remains compliant with all delegated credentialing requirements.
This position also serves as one of the key subject matter experts for the system for any education related to insurance industry changes, managed care regulation, and impactful payer policies/protocol changes. The position serves as an internal resource and external liaison for managed care matters, coordinating input from Revenue Cycle, Payer Analytics, Legal, Finance, and clinical leadership to implement and operationalize payer strategies, policies or protocols and escalate health system payer issues.
Education
Bachelor's Degree required.
Experience
- A minimum of five years' experience in managed care in a health care setting (medical office/hospital/insurance) required.
- Knowledge of the healthcare industry and payor reimbursement methodologies.
- A minimum of three years' experience in payer enrollment with experience with delegated credentialing strongly preferred.
Skills
- Leadership and team management
- Managed care and payer operations expertise
- Provider enrollment and delegated credentialing knowledge
- Healthcare reimbursement and payer relations experience
- Strategic planning and operational oversight
- Process improvement and workflow optimization
- Analytical and problem-solving skills
- Contract interpretation and regulatory compliance
- Cross-functional collaboration and stakeholder management
- Strong written, verbal, and presentation skills
- Performance measurement and data analysis
- Change management and organizational influence
- Relationship management and customer service excellence
Requirements
- Bachelor's Degree required
- A minimum of five years' experience in managed care in a health care setting (medical office/hospital/insurance) required
- Knowledge of the healthcare industry and payor reimbursement methodologies
- A minimum of three years' experience in payer enrollment
- Experience with delegated credentialing strongly preferred
- Leadership and team management
- Managed care and payer operations expertise
- Provider enrollment and delegated credentialing knowledge
- Healthcare reimbursement and payer relations experience
- Strategic planning and operational oversight
- Process improvement and workflow optimization
- Analytical and problem-solving skills
- Contract interpretation and regulatory compliance
- Cross-functional collaboration and stakeholder management
- Strong written, verbal, and presentation skills
- Performance measurement and data analysis
- Change management and organizational influence
- Relationship management and customer service excellence
Benefits
- Medical, Dental & Vision
- Group Term Life Insurance
- AD&D Insurance
- Flexible Spending Accounts
- Commuter Benefit Plans
- Supplemental Voluntary Benefits
- Short-Term Disability
- Long-Term Disability
- Whole Life Insurance
- Legal Support
- 6 Paid Holidays
- Paid Time Off
- Wellness Time Off
- Extended Illness Leave
- Retirement Plan
- Tuition Assistance
- Employee Assistance Program
- Fitness Center Discount
- Daycare Discounts
Company overview
The Valley Health System is an integrated healthcare network serving Las Vegas and Southern Nevada, operating as a subsidiary of Universal Health Services, Inc. (UHS). Established in 1979, the system has grown to become the largest provider of healthcare services in Southern Nevada, serving over two million residents across the region. The network comprises six acute care hospitals, two specialty hospitals, seven freestanding emergency departments, and numerous outpatient facilities and physician practices. Key hospitals include Centennial Hills Hospital Medical Center, Henderson Hospital, Spring Valley Hospital Medical Center, Summerlin Hospital Medical Center, Valley Hospital Medical Center, and West Henderson Hospital. The system offers comprehensive medical services including emergency care, cardiovascular services, neurosciences, maternity and women's health, orthopedics, oncology, behavioral health, and specialized programs in stroke and heart attack care. All Valley Health System hospitals are accredited by The Joint Commission and consistently earn national recognition for quality care, with certifications from the American Heart Association and American Stroke Association. The organization employs over 9,000 healthcare professionals dedicated to providing patient-centered care while also serving as a teaching institution with graduate medical education programs and clinical training opportunities for future healthcare providers.