Associate Director, Payer Enrollment

Privia Health

2d•$90,000 - $95,000

About The Position

The Associate Director of Provider Enrollment provides strategic oversight and operational leadership to ensure the seamless integration of practitioners into Privia’s network. This role serves as the primary liaison between clinical care centers, Revenue Cycle Management (RCM), and insurance carriers, managing the complexities of commercial and government enrollment to minimize credentialing delays. By optimizing internal workflows and maintaining strong payer relationships, you will play a vital role in preventing revenue leakage and supporting the organization’s financial stability. At Privia, you will lead a dedicated team in a collaborative environment where operational precision directly enables our providers to deliver high-quality, uninterrupted patient care.

Requirements

7+ years’ experience in managed care credentialing, billing and/or Medical Staff service setting
Experience leading Enrollment teams with large provider inventory
Demonstrated skills in problem solving, analysis and resolution
Intermediate/advanced Microsoft Excel skills required
Experience supporting Medicare/Medicaid required
Must be able to function independently, possess demonstrated flexibility in multiple project management
Must comply with HIPAA rules and regulations

Nice To Haves

Experience using Verity CredentialStream preferred
Athena EMR experience preferred
Strong knowledge of NCQA guidelines & delegated payers preferred

Responsibilities

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
Assures compliance 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 provide regular updates and resolve complex provider enrollment status and/ or issues, including resolving claim denials related to provider enrollment
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
Oversees 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.
Mentor and train new and existing staff.
Autonomously lead meetings with key internal and external stakeholders.
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.