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Credentialing & Enrollment Specialist - Houston
Revenue Cycle Management
Houston, TX
Full Time

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Title/Position: Credentialing & Enrollment Specialist

Department or Business Unit: Credentialing

Employment Type: FTE

Exemption Status: Non-Exempt

Min. Experience: Entry-Level

Travel Required: No


Overview of the Role: 


Privia Health is currently looking for a Credentialing & Enrollment Specialist to join our rapidly growing team! This person will support all aspects of the credentialing, re-credentialing and privileging processes for all providers in Privia’s high performance medical group.   


Primary Job Duties: 


  • Data Collection & Management
    • Collects provider credentials and updates internal and external databases 
    • Reviews and streamlines processes and workflows for the on-boarding department, using automation where appropriate 
    • Assures compliance with all state laws, internal policies and health plan requirements as related to the provider certification and credentialing 
    • Interacts with varied levels of management, physician office staff and physicians effectively to accomplish credentialing and various elements 
    • Works with technical staff to develop tools and procedures for auditing and reporting with the goal of streamlining credentialing processes and communicating with company and external stakeholders
  • Project Management 
    • Maintain up-to-date data for each provider in credentialing databases and online systems
    • Coordinate and prepare reports
    • Record and track credentialing statistics
    • Interacts with varied levels of management, physician office staff and physicians effectively to accomplish credentialing and various elements of implementation and launch
    • Maintains confidentiality of provider information

Minimum Qualifications:

  • 3-5 years’ experience in managed care credentialing, billing and/or Medical Staff service setting
  • Demonstrated skills in problem solving analysis and resolution 
  • Attention to detail 
  • Must be able to function independently, possess demonstrated flexibility in multiple project management 
  • Must comply with HIPAA rules and regulations 

Interpersonal Skills & Attributes:

  • 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 
  • Team approach to working with others, ability to perform a variety of duties within any work-day and organizational skills from planning to execution of tasks and projects
  • Project coordination experience
  • Process oriented with the ability to drive a project to completion 
  • Eager to embrace the challenges and opportunities to build a Credentialing department within a rapidly growing startup environment 
  • An individual who is passionate about playing a key role in changing the current healthcare environment

Physical Demands:

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. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.


Technical Requirements:

In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like https://www.bing.com/search?q=speedtest. This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.


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