Enrollment Specialist (New Jersey)

Privia Health•Remote, USA

3d•$50,000 - $55,000•Hybrid

About The Position

The Enrollment Specialist will be the primary contact for the New Jersey Market’s Enrollment Department for all Privia independent providers and care centers, and responsible for all aspects of managing the payer enrollment process. The Enrollment Specialist will take steps necessary to enroll all new groups and providers with the contracted payers in the Florida market, including all commercial and federal payers. The Enrollment Specialist will manage all payer data in CredentialStream for both the group and the individual providers. The Enrollment Specialist will take steps necessary to investigate all claims/enrollment related issues or questions with the care centers. Work within AthenaOne EMR to resolve inbound claims related inquiries. Partners with internal and external partners in the onboarding process including the National Credentialing Team, Implementation Team, and Operations Consultants. Resolution of Salesforce cases and management of issues and the team resolving the cases is a key element in this role. Act as liaison between Enrollment Department and both internal and external stakeholders. Other duties as assigned.

Requirements

2+ years’ experience in payer enrollment function
Medicare/Medicaid payer experience required
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
Ability to communicate appropriately and effectively with providers; including sensitive and confidential information
High level of attention to detail with exceptional organizational skills
Exercise independent judgment
Ability to problem solve and explore all options and to use available resources to find new and effective solutions

Nice To Haves

Verity CredentialStream or other credentialing experience preferred
Familiar with working in PECOs preferred
Experience working with providers & payers in New Jersey preferred
Athena EMR experience preferred

Responsibilities

Enroll all new groups and providers with the contracted payers in the Florida market, including all commercial and federal payers.
Manage all payer data in CredentialStream for both the group and the individual providers.
Investigate all claims/enrollment related issues or questions with the care centers.
Work within AthenaOne EMR to resolve inbound claims related inquiries.
Partner with internal and external partners in the onboarding process including the National Credentialing Team, Implementation Team, and Operations Consultants.
Resolve Salesforce cases and manage issues.
Act as liaison between Enrollment Department and both internal and external stakeholders.
Perform other duties as assigned.