Provider Credentialing Onboarding Lead

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 Onboarding Lead is a high-impact, customer-focused role responsible for ensuring a seamless, efficient, and concierge-level onboarding experience for all new healthcare providers. This role acts as the primary, single point of contact and dedicated liaison between the provider and the internal Credentialing, Payer Enrollment, and Operations teams. The Lead is accountable for driving the end-to-end credentialing and enrollment lifecycle, meeting critical deadlines, and proactively resolving complex, interdepartmental roadblocks to ensure providers meet their target start dates and begin patient care promptly.

• Concierge Provider Management & Liaison:
  • Serve as the dedicated, single point of contact for new providers from the offer acceptance stage through successful completion of both credentialing and payer enrollment processes.
  • Provide a proactive, high-touch communication experience, managing expectations, answering complex questions, and ensuring transparency throughout the entire onboarding journey.
  • Act as a central liaison, facilitating clear and timely communication between the provider, Credentialing team, Enrollment team, Recruitment, and other operational departments.
  • Maintain meticulous records of all provider outreach and documentation, and report on the status and health of the onboarding pipeline to leadership.
     
• End-to-End Credentialing and Enrollment Execution:
  • Document and Data Management: Oversee and execute the collection of all necessary documentation (licensure, certifications, malpractice, etc.) required for both primary source verification (Credentialing) and health plan participation (Payer Enrollment).
  • Internal Profile Completion: Perform precise and timely data entry and profile creation in internal systems and databases (e.g., credentialing software, HRIS, EMR), ensuring consistency and accuracy across all platforms.
  • Proactively track and manage all critical milestones, target dates, and regulatory deadlines for initial credentialing, reappointment, and enrollment applications, escalating risks to leadership immediately.
  • Ensure all credentialing applications, CAQH profiles, and payer enrollment documents are completed, audited for accuracy, and submitted with precision and expediency.
• Process Leadership & Strategic Improvement:
  • Proactively identify, investigate, and develop solutions to a variety of complex issues and roadblocks, often involving interdepartmental coordination or regulatory interpretation.
  • Operate under minimal direction, exercising significant judgment and decision-making authority in accordance with organizational policies and processes to expedite file completion.
  • Influence and contribute to the strategy and goal setting for the credentialing and onboarding team by providing deep insights into process bottlenecks and provider experience pain points.
  • Regularly provide coaching, guidance, and training to early career employees, ensuring all completed files and applications meet advanced quality and compliance standards.
  • All other duties, as assigned.

Qualifications

• 5+ years of experience in healthcare credentialing, provider enrollment, or provider relations, specifically involving primary source verification and managed care contracting/enrollment.
• Demonstrated experience managing high-volume or complex provider onboarding pipelines in a non-hospital or physician practice setting.
• In-depth knowledge of CMS requirements, State-Specific Payer Enrollment Regulations, and compliance standards (e.g., NCQA).
• Proficiency with credentialing software and managing provider data in CAQH.
• High School Diploma or equivalent experience.
• Attention to Detail: Meticulous attention to detail and accuracy in data management and documentation.
• Advanced Knowledge: Applies advanced knowledge of healthcare credentialing and payer enrollment practices, skills, and procedures to consistently complete projects on time and drive efficiency.
• Judgement & Problem Solving: Proactively resolves complex operational challenges, dev