Payor Enrollment Specialist

Privia Health•Houston, TX

1d•$50,000 - $60,000•Hybrid

About The Position

The Payor Enrollment Specialist manages credentialing, re-credentialing, privileging, and provider enrollment processes for providers launching in Privia’s high-performance medical group. This full-time hybrid role is based at the Houston office at 1200 Binz St Suite 1490, with in-office work on Tuesdays and Thursdays. Mondays, Wednesdays, and Fridays are typically work from home, though occasional office attendance may be required. The position ensures timely, accurate enrollment and credentialing, supports process improvements and issue resolution, and coordinates information among payers, contracted MSO facilities, Privia Medical Group, providers, and internal stakeholders.

Requirements

At least 3 years of experience in managed care credentialing.
Provider enrollment experience.
Demonstrated problem-solving, analytical, and resolution skills.
Advanced Microsoft Excel skills.
Ability to work independently and demonstrated flexibility in managing multiple projects.
Ability to communicate appropriately and effectively with practitioners, internal stakeholders, and providers, including when handling sensitive and confidential information.
Strong attention to detail and exceptional organizational skills.
Ability to exercise independent judgment when interpreting guidelines from applicable regulatory bodies.
Ability to comply with HIPAA rules and regulations.

Responsibilities

Ensure protocols are followed to complete payor enrollment on time and prevent revenue loss due to delays.
Follow health plan requirements and guidelines for provider certification and credentialing.
Review and streamline onboarding processes and workflows, using automation where appropriate.
Work with internal and external stakeholders to resolve complex provider enrollment issues, including claim denials related to enrollment.
Support special projects involving delegated and non-delegated health plan requirements.
Interact effectively with management, physician office staff, and physicians to accomplish credentialing and implementation and launch activities.
Maintain current provider data in credentialing databases and online systems, and ensure timely renewal of licenses and certifications.
Maintain the confidentiality of provider information.
Help manage information flow among payers, contracted MSO facilities, and Privia Medical Group.
Coordinate and prepare reports.
Record and track credentialing statistics.
Perform other duties as assigned.