Provider Enrollment Manager - Department Promotion

Description

Under general direction of and in cooperation with the Director of Health Care Agency (HCA) Medical Staff Administration, the Provider Enrollment Manager will oversee the systems for third party plan payor enrollments throughout the HCA.

IDEAL CANDIDATE

The ideal candidate will be an effective manager who maintains a professional, pleasant, and respectful demeanor with all levels of staff in a fast-paced environment. This person will have strong communication, interpersonal, and administrative/office skills, as well as substantial experience with third party payor enrollments and interpreting practitioner and payor contracts.

EDUCATIONAL/BILINGUAL INCENTIVE:

Possible educational incentive of 2.5%, 3.5%, or 5% based on completion of Associate's, Bachelor's, or Master's degree. Incumbents may also be eligible for bilingual incentives depending upon operational need and certification of skill.

PAYROLL TITLE:

Program Administrator II

Program Administrator II is a management classification and is not eligible for overtime compensation. Incumbents in these classifications are eligible for benefits at the MB4 level.

AGENCY/DEPARTMENT:

Health Care Agency – Ventura County Medical Center/Santa Paula Hospital

The eligible list established from this recruitment may be used to fill current and future Regular, Temporary, Fixed-term, Intermittent, or Extra Help vacancies for this position only. There is currently one (1) Full-time Regular vacancy.

TENTATIVE SCHEDULE

OPENING DATE: 9/28/2026

CLOSING DATE: 10/9/2026

Examples Of Duties

• Manages/oversees the provider enrollment operations with private and government payors;
• Oversees the efficiency and accuracy of the provider enrollment vendor activities and billing processes;
• Oversees the monthly health plan rosters and timely communication of roster changes;
• Manages and maintain database provider enrollment records in MDStaff;
• Collaborate with the Hospital Medical Staff credentialing team regarding provider data necessary for timely payor enrollments;
• Monitors and investigates payor denials related to enrollments and roster discrepancies;
• Develops/manages department enrollment policies & procedures;
• Manages distribution and attestation process of health plan specific orientation/training requirements;
• Maintains documents related to enrollments and the provider enrollment applications;
• Manages the annual provider certificates of insurance in collaboration with the Agency’s malpractice carrier;
• Drafts database enrollment related reports to support the enrollment process;
• Creates accounts related to Practitioner Cerner HNAuser and Bedrock;
• Supervise and trains administrative support staff;
• Performs other related duties as required.

Typical Qualifications

These are entrance requirements to the examination process and ensure neither continuance in the process nor placement on an eligible list.

DEPARTMENT/AGENCY SERVICE:

Currently working as a Regular employee for the County of Ventura Health Care Agency.

NOTE: A Regular employee is an employee who holds an allocated full-time or part-time position in the County budget excluding (but not limited to) extra help or intermittent employees, provisional appointees, enrollees in training programs, and/or independent contractors.

EDUCATION, TRAINING, And EXPERIENCE

Considerable administrative skills coupled with some experience in provider enrollment which demonstrate possession of and competency in the required knowledge, skills and abilities.

An example of the qualifying experience can be obtained by:

• Four (4) years of experience with administrative functions, including experience with the life cycle of provider enrollment and/or provider credentialing.

Necessary Special Requirements

• Intermediate skills with Microsoft Word and Excel
• Effective communication as demonstrated by application and supplemental question responses

DESIRED

• Experience with provider enrollment and/or provider credentialing within a public health care system, such as hospitals, clinics, or other health care organizations.
• Experience using online provider enrollment and credentialing databases and portal systems, such as MD-Staff, PAVE (Medi-Cal), and PECOS (Medicare).
• Experience in preparing professional reports and documentation.
• National Association of Medical Staff Services (NAMSS) certification in one of the following:
• Certified Provider Credentialing Specialist (CPCS)
• Certified Provider Enrollment Specialist (CPES)Provider Enrollment Specialist Certificate (PESC)
• Willingness to obtain a relevant professional certification within two (2) years of becoming eligible to sit for the examination.

Knowledge of:

medical staff organization and health plan provider enrollment functions.

Ability to:

interpret and implement health plan accreditation and contract requirements; research and implement current best practices; utilize credentialing software programs; plan, organize, and supervise the work of others; build and maintain effective professional relationships with others; and communicate effectively in an oral and written manner.

Skill in:

Microsoft Word, Excel, and online portal database systems.

EQUAL EMPLOYMENT OPPORTUNITY

The County of Ventura is an equal opportunity employer to all, regardless of age, ancestry, color, disability (mental and physical), exercising the right to family care and medical leave, gender, gender expression, gender identity, genetic information, marital status, medical condition, military or veteran status, national origin, political affiliation, race, religious creed, sex (includes pregnancy, childbirth, breastfeeding, and related medical conditions), and sexual orientation.