Senior Manager, Open Market Residential
WM
Payer Enrollment Manager, Healthcare Revenue Cycle
Guidehouse
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $77,000 - $129,000 per year
Job Level
SeniorLead
About the role
- Lead and oversee payer enrollment operations across UAB Medicine, UAB St. Vincent’s, and affiliated entities
- Manage both delegated and direct enrollment functions, payer relationships, and system integrity
- Coordinate projects and issues with the MDSO and Managed Care Contracting and staff performance across multiple teams
- Serve as the primary operational and strategic leader ensuring efficient and compliant enrollment of providers with government and commercial payers
- Partner with Revenue Cycle leadership, contracting, and credentialing teams to align enrollment efforts with organizational priorities
- Serve as the key representative in planning meetings, payer strategy sessions, and system initiatives
- Directly manage the MSO Enrollment team and Payer Enrollment staff supporting affiliated organizations; supervise Enrollment Leads and MSO Enrollment Supervisor
- Oversee staffing models, resource allocation, and establish structure and accountability for supervisory-level staff
- Manage delegated roster submissions, direct enrollment workflows, recredentialing, demographic updates, and compliance-driven enrollment maintenance tasks
- Serve as the primary operational escalation point for provider setup, billing delays, or denials related to enrollment
- Lead system oversight and optimization for MD-Staff and ensure continuity of Symplr usage during transitions
- Partner with system teams to align Athena One, IDX, and Epic for billing readiness, enrollment holds, and denial resolution
- Represent the enrollment function in Revenue Cycle leadership meetings and payer operations workgroups
- Collaborate with AR follow-up, billing teams, MDSO, CVO, Managed Care Contracting and other stakeholders to resolve payer enrollment-related issues
- Develop, maintain, and enforce standard operating procedures; identify opportunities for automation, reporting, and workflow redesign
- Track KPIs and prepare leadership reports on enrollment status, backlog, processing timelines, and issue resolution trends
- Ensure all delegated enrollment activities meet contractual obligations and are audit ready
Requirements
- Requires a Bachelor's Degree and a minimum 7 years of prior relevant experience OR Associate's Degree and a minimum 9 years of prior relevant experience
- Relevant experience may be substituted for formal education or advanced degree
- At least three (3) years in payer enrollment, credentialing, or managed care operations
- Relevant experience coming from a healthcare provider, payor, CBO, business office environment or an outsourcing company
- Demonstrated experience overseeing payer enrollment across multiple provider organizations or departments (preferred)
- Proficiency with enrollment and credentialing systems: MD-Staff – required for delegated enrollment and system customization
- Symplr – preferred for systems support during UAB Medicine’s transition
- Experience with billing systems and claim platforms: Athena One, IDX, and Epic – required for enrollment holds, denials, and billing readiness integration
- Ability to lead and scale teams during organizational growth
- Ability to align enrollment functions with Revenue Cycle strategy and planning
- Ability to implement automation, reporting tools, and operational process improvements
- Excellent communication and stakeholder management skills, including presenting to senior leadership and navigating cross-departmental alignment
- Travel Required: Up to 25%
