Payer & Provider Enrollment Specialist

Privia Health

17h•$25 - $26•Remote

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

3+ 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

Nice To Haves

Verity CredentialStream or other credentialing experience preferred
Athena EMR experience preferred

Responsibilities

The Sr 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 athenaNet 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