Overview of the Role:
Privia Health is currently looking for a Credentialing & Enrollment Specialist to join our rapidly growing team! This person will be responsible for all aspects of the credentialing, re-credentialing and privileging processes for launching all providers in Privia’s high performance medical group.
Primary Job Duties:
- Process payer enrollment rosters for healthcare providers for Medicare, Medicaid, Commercial Managed Care and Marketplace plans
- Reviews and streamlines processes and workflows for the on-boarding department, using automation, where appropriate
- Maintain up-to-date data for each provider in credentialing databases, practice management system and other online systems; ensure timely renewal of licenses and certifications.
- Responsible for preparing quarterly rosters for delegated payer audits
- Works with AVP to develop tools and procedures for auditing and reporting with the goal of streamlining provider enrollment processes and communicating with market internal and external stakeholders
- Oversees special projects requiring knowledge of delegated and non-delegated health plan requirements
- Interacts with internal departments, varied levels of management, physicians and physician’s office staff effectively to accomplish provider enrollments timelines
- Assist in managing the flow of information between the payers, contracted MSO facilities and PMG
- Coordinate and prepare reports
- Record and track credentialing statistics
- Ensure provider participation with contracted payor by taking appropriate actions to complete enrollment
- Work with Credentialing Department, payors and providers to ensure compliance with enrollment processes
- Review active roster to ensure all providers have payor numbers and/or going through the enrollment process
- Review correspondence received from payor and providers and perform appropriate action to resolve
- Triage Salesforce Credentialing cases and provide resolution in a timely fashion
- Appropriately resolve or escalate provider enrollment issues with payer representatives
- 5 years’ experience in managed care credentialing, billing and/or Medical Staff service setting
- Demonstrated skills in problem solving and analysis and resolution
- Must be able to function independently, possess demonstrated flexibility in multiple project management
- Must comply with HIPAA rules and regulations
Interpersonal Skills & Attributes:
- Eager to embrace the challenges and opportunities to build a Provider Enrollment department with in a rapidly growing start-up environment
- An individual with the ability to communicate appropriately and effectively with practitioners and providers; including sensitive and confidential information
- An individual who is passionate about playing a key role in changing the current healthcare environment
- High level of attention to detail with exceptional organizational skills
- Ability to problem solve and explore all options and to use available resources to find new and effective solutions
Google Suite (including Chat)
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is required to sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; talk and hear. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.
Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. Privia is a better company when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age, color, national origin, physical or mental (dis)ability, race, religion, gender, sex, gender identity and/or expression, marital status, veteran status, or any other characteristic protected by federal, state or local law.
Privia is dedicated to providing reasonable accommodations for individuals who may need assistance. If you or any other individual is interested in working at Privia and may need assistance in the application process, please contact us at firstname.lastname@example.org so we can be of support.