Director, Provider Enrollment

Alignment Health

. Lead the end-to-end provider enrollment function from contract execution through provider activation .

Posted 9/30/2026full-timeRemote • United StatesLead💰 $126,422 - $189,634 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates extensive expertise in provider enrollment operations, including delegated credentialing and compliance with CMS and NCQA requirements. Proven ability to lead teams, develop standardized procedures, and implement quality controls to enhance operational performance.

Highest-signal resume keywords

Healthcare Operations ExperienceProvider Enrollment ManagementDelegated Credentialing GovernanceStakeholder ManagementAnalytical Leadership Skills

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Provider EnrollmentCredentialingProvider Data ManagementNetwork OperationsContract ImplementationQuality Assurance ProcessesData ValidationPerformance Metrics DevelopmentOperational ComplianceProcess Improvement

Soft Skills

LeadershipCommunicationStakeholder ManagementMentoringAnalytical Thinking

Tools & Technologies

Operational SystemsDashboardsAutomation ToolsWorkflow Optimization Solutions

Industry Keywords

CMS ComplianceNCQA StandardsHealthcare AdministrationManaged CareProvider Directory Accuracy

About the role

Key responsibilities & impact

Lead the end-to-end provider enrollment function from contract execution through provider activation
Oversee provider and entity onboarding activities for contracted providers, facilities, ancillary providers, IPAs, and delegated entities
Establish governance for contract implementation workflows across contracting, credentialing, enrollment, and provider data teams
Ensure provider records are accurately configured across downstream operational systems
Develop standardized enrollment procedures, controls, and quality assurance processes
Manage delegated credentialing roster submissions, provider loads, onboarding standards, loading protocols, and validation controls
Partner with Delegation Oversight teams to meet regulatory, contractual, and accreditation requirements
Monitor delegated provider load accuracy, turnaround times, and service-level agreement compliance
Lead remediation for roster discrepancies and audit findings
Oversee non-participating and non-contracted provider enrollment processes, policies, workflows, monitoring, and reporting
Partner with Claims, Network Management, and Provider Data teams to support accurate claims adjudication and provider identification
Establish provider enrollment data standards and quality controls
Lead data validation, reconciliation, and audit activities
Develop performance metrics and dashboards for provider onboarding, delegate load performance, inventory aging, and enrollment cycle times
Support provider directory accuracy and provider data integrity initiatives
Ensure compliance with CMS, NCQA, state, and accreditation requirements
Support audits, surveys, and delegated oversight reviews
Maintain compliance policies, procedures, and documentation
Implement controls to mitigate operational and compliance risks
Lead, develop, and mentor provider enrollment managers and operational teams
Establish productivity, quality, and service performance standards
Drive process improvement through automation, workflow optimization, and technology solutions
Partner with executive leadership on network growth, market expansion, and strategic provider initiatives
Manage departmental budgets, vendor relationships, and operational performance

Requirements

What you’ll need

10+ years of healthcare operations experience within a health plan, managed care organization, provider network, or healthcare administration environment
5+ years of leadership experience managing provider enrollment, credentialing, provider data management, network operations, or related functions
Demonstrated experience managing delegated credentialing programs and provider roster governance
Experience overseeing provider contract implementation and onboarding operations
Strong knowledge of provider data, credentialing, enrollment, and network management processes
Bachelor's degree in healthcare administration, Business Administration, Public Health, or related field
Deep understanding of provider enrollment operations, delegated credentialing, delegation oversight, provider data management, network administration, non-par and out-of-network provider processing, CMS and NCQA requirements, provider directory accuracy standards, and claims and downstream operational impacts
Strong analytical and operational leadership skills
Excellent stakeholder management and executive communication capabilities