Payer & Provider Enrollment Specialist

Privia Health

11d•$50,000 - $55,000

About The Position

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. The Enrollment Specialist will be the primary contact for the Enrollment Department for all Privia independent providers and responsible for all aspects of managing the payer enrollment process.

Requirements

2+ years’ experience in payer enrollment function
Medicare/Medicaid payer experience required
Demonstrated skills in problem solving and analysis and resolution
Must be able to function independently, possess demonstrated flexibility in multiple project management
Must comply with HIPAA rules and regulations
An individual with the ability to communicate appropriately and effectively with providers; including sensitive and confidential information
An individual who is passionate about playing a key role in changing the current healthcare environment
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

Delegated and Non Delegated payer enrollment experience preferred
Experience with RCM - Enrollment claim resolution
Verity CredentialStream or other credentialing software experience preferred

Responsibilities

Enrolls providers new to Privia with all commercial health plans specific to the market.
Enrolls providers new to Privia with both Medicaid and Medicare.
Data enters "add to roster" date in CredentialStream.
Data enters "submitted" and "mailed" dates in CredentialStream.
Data enters "effective" date in CredentialStream.
Reviews data in provider record, specifically taxonomy and specialty, and ensures it is correct prior to submitting applications.
Performs follow up with health plans 30 days after submission and then biweekly thereafter until the provider is PAR.
Escalates known issues to manager for assistance.
Collaborates with credentialing team regularly to ensure that there is an awareness of all new providers who are onboarding.
Attends RCM and payer calls as needed as well as any other internal stakeholder meeting that may involve their market, as needed.
Other duties as assigned.