Provider Credentialing Onboarding Lead

Privia Health

3d•$72,000 - $80,000

About The Position

The Credentialing Onboarding Lead is a high-impact, customer-focused role responsible for ensuring a seamless, efficient, and concierge-level onboarding experience for all new healthcare providers. This role acts as the primary, single point of contact and dedicated liaison between the provider and the internal Credentialing, Payer Enrollment, and Operations teams. The Lead is accountable for driving the end-to-end credentialing and enrollment lifecycle, meeting critical deadlines, and proactively resolving complex, interdepartmental roadblocks to ensure providers meet their target start dates and begin patient care promptly.

Requirements

5+ years of experience in healthcare credentialing, provider enrollment, or provider relations, specifically involving primary source verification and managed care contracting/enrollment.
Demonstrated experience managing high-volume or complex provider onboarding pipelines in a non-hospital or physician practice setting.
In-depth knowledge of CMS requirements, State-Specific Payer Enrollment Regulations, and compliance standards (e.g., NCQA).
Proficiency with credentialing software and managing provider data in CAQH.
High School Diploma or equivalent experience.
Attention to Detail: Meticulous attention to detail and accuracy in data management and documentation.
Advanced Knowledge: Applies advanced knowledge of healthcare credentialing and payer enrollment practices, skills, and procedures to consistently complete projects on time and drive efficiency.
Judgement & Problem Solving: Proactively resolves complex operational challenges, developing solutions that align with organization values and ensure regulatory compliance.
Communication & Collaboration: Excellent written and verbal communication skills, with a proven ability to maintain strong, professional relationships with providers, leadership, and cross-functional teams

Nice To Haves

Certification as a Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) preferred.
Experience in a role focused on "concierge" client service preferred
Experience working with multi-state credentialing and enrollment preferred.

Responsibilities

Serve as the dedicated, single point of contact for new providers from the offer acceptance stage through successful completion of both credentialing and payer enrollment processes.
Provide a proactive, high-touch communication experience, managing expectations, answering complex questions, and ensuring transparency throughout the entire onboarding journey.
Act as a central liaison, facilitating clear and timely communication between the provider, Credentialing team, Enrollment team, Recruitment, and other operational departments.
Maintain meticulous records of all provider outreach and documentation, and report on the status and health of the onboarding pipeline to leadership.
Document and Data Management: Oversee and execute the collection of all necessary documentation (licensure, certifications, malpractice, etc.) required for both primary source verification (Credentialing) and health plan participation (Payer Enrollment).
Internal Profile Completion: Perform precise and timely data entry and profile creation in internal systems and databases (e.g., credentialing software, HRIS, EMR), ensuring consistency and accuracy across all platforms.
Proactively track and manage all critical milestones, target dates, and regulatory deadlines for initial credentialing, reappointment, and enrollment applications, escalating risks to leadership immediately.
Ensure all credentialing applications, CAQH profiles, and payer enrollment documents are completed, audited for accuracy, and submitted with precision and expediency.
Proactively identify, investigate, and develop solutions to a variety of complex issues and roadblocks, often involving interdepartmental coordination or regulatory interpretation.
Operate under minimal direction, exercising significant judgment and decision-making authority in accordance with organizational policies and processes to expedite file completion.
Influence and contribute to the strategy and goal setting for the credentialing and onboarding team by providing deep insights into process bottlenecks and provider experience pain points.
Regularly provide coaching, guidance, and training to early career employees, ensuring all completed files and applications meet advanced quality and compliance standards.
All other duties, as assigned.