Credentialing & Enrollment Specialist

Company Description

Privia Health™ is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.

Job Description

The Credentialing & Enrollment Specialist is responsible for all aspects of the credentialing, re-credentialing and privileging processes for all launching all providers in Privia’s high-performance medical group.

Primary Job Duties:

• Ensure protocols are being followed to ensure timely resolution and completion of payor enrollment to ensure no loss of revenue due to untimely payor enrollment

• Follows guidelines in alignment with all health plan requirements as related to the provider certification and credentialing. 

• Reviews and streamlines processes and workflows for the on-boarding department, using automation, where appropriate

• Works with both internal and external stakeholders to resolve complex provider enrollment issues, including resolving claim denials related to provider enrollment 

• Supports special projects requiring knowledge of delegated and non-delegated health plan requirements

• Interacts with varied levels of management, physician office staff and physicians effectively to accomplish credentialing and various elements of implementation and launch

• Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications. 

• Maintains confidentiality of provider information

• Assist in managing the flow of information between the payers, contracted MSO facilities and PMG

• Coordinate and prepare reports

• Record and track credentialing statistics

• Other duties as assigned.

Qualifications

• 2+ years experience in managed care credentialing, billing and/or Medical Staff service setting

• Demonstrated skills in problem solving and analysis and resolution

• Advanced Microsoft Excel skills

• Must be able to function independently, possess demonstrated flexibility in multiple project management 

• Must comply with HIPAA rules and regulations

• Experience using Verity software preferred
• Experience using Athena EMR preferred
• Experience using Salesforce RCM preferred
• Experience using Monday.com preferred 

Interpersonal Skills & Attributes:

• An individual with the ability to communicate appropriately and effectively with practitioners, internal stakeholders, and providers; including sensitive and confidential information

• High level of attention to detail with exceptional organizational skills

• Exercise independent judgment in interpreting guidelines of applicable regulatory bodies.

Colorado, New York, New Jersey, California and Washington Residents Only: The salary range for this role is $50,000.00-$60,000.00 in base pay and exclusive of any bonuses or benefits. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

Additional Information

All your information will be kept confidential according to EEO guidelines.

Technical Requirements (for remote workers only, not applicable for onsite/in office work):

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.speedtest.net/. 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.

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 peop