Lead, Provider Enrollment

Ventra Health

2 - 5 years

5 - 8 Lacs

chennai

Posted:None| Platform:

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Skills Required

accounts receivable providing hipaa medicaid us healthcare claims adjudication healthcare bpo enrollment healthcare claims processing payment posting ar calling denial management credentialing claims medical billing rcm medicare revenue cycle management

Work Mode

Work from Office

Job Type

Full Time

Job Description

Overview

The
Team Lead, Provider Enrollment
plays a key leadership role in the Provider Enrollment department, acting as a mentor, subject matter expert, and operational resource for a team of enrollment specialists. This role supports the Supervisor and Manager by overseeing daily workflows, resolving escalated issues, and ensuring enrollment tasks are completed accurately and in a timely manner. The Team Lead works collaboratively across internal teams and with external payers to support efficient provider onboarding and compliance with payer requirements.

Responsibilities

Lead, mentor, and support a team of Provider Enrollment Specialists in their daily tasks and development.
Assist with onboarding and training new team members; develop and maintain training materials and SOPs.
Monitor daily workload queues to ensure timely completion of enrollment tasks and proper case prioritization.
Serve as the first point of escalation for complex enrollment issues or payer communication delays.
Perform advanced follow-up with CMS, Medicaid, and third-party payers to resolve issues and ensure timely application processing.
Ensure the accurate submission, tracking, and follow-up of CMS Medicare, State Medicaid, and commercial payer applications.
Audit provider enrollment records and documentation to ensure compliance with internal standards and external payer requirements.
Partner with clients, market locations, operations personnel, and revenue cycle stakeholders to facilitate smooth provider onboarding and ongoing maintenance.
Proactively manage payer revalidation schedules and ensure timely renewals to prevent lapses in enrollment or deactivation.
Track and maintain documentation of enrollment activities in all applicable systems.
Maintain up-to-date knowledge of payer rules, credentialing requirements, and regulatory changes impacting provider enrollment.
Contribute to process improvement initiatives and help drive efficiency across the team.
Perform special projects and other duties as assigned.

Qualifications

High School diploma or equivalent.
2+ years of experience in provider enrollment, credentialing, or payer relations within a healthcare or RCM environment.
1+ year of experience in a lead or supervisory role preferred.

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