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About the Role
The Director of Payer Enrollment provides strategic leadership for the full payer enrollment team, owning payer enrollment metrics and bringing an executive-level presence to customer relationships. This role leads enrollment strategy for strategic customers and partners closely with various internal teams.
Responsibilities
- Own turnaround, quality, and rework across the full payer enrollment team (commercial, government, and contracting).
- Oversee the Contracting team, ensuring timely implementation and receipt of customer health plan contracts, process reviews, and consistent 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).
- 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.
Requirements
- 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.
- Experience with automation or AI agents, including knowing when not to use them.
Skills
- Payer enrollment
- Operations management
- Contracting
- Customer relationship management
- Regulatory compliance
- KPI tracking
- Process improvement
- Project management
- Analytical skills
- Problem-solving
- Communication
- Team leadership
- Healthcare software systems
- Microsoft Office Suite
- Automation
- AI agents
Experience Level
- Director