RCM Systems & Enrollment Analyst

Privia Health

21h•Hybrid

About The Position

RCM Systems & Enrollment Analyst is a critical role responsible for identifying, analyzing, and resolving conflicts and inconsistencies across revenue cycle management (RCM) and provider credentialing and enrollment processes. This individual will focus on preventing revenue leakage by ensuring data integrity across all systems, validating system configurations, and driving cross-departmental process improvements.

Requirements

Bachelor's degree in Healthcare Administration, Finance, Business, or a related field preferred, or equivalent work experience
At least 3 years experience in managed care credentialing, billing and/or Medical Staff service setting
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
Prefer knowledge of EFT, ERA, EDI enrollment and claims systems.
Must have Athena system knowledge.
Knowledge of Athena payer enrollment table strongly desired

Responsibilities

Under the direction of the Senior Manager, Athena Systems, completes all EFT, ERA, EDI set up and enrollment with all health plans through claims system or payor portal.
Conducts regular follow up with all health plans to obtain statuses of provider submissions.
Works with other Privia partners is addressing any provider enrollment issues.
Identify and resolve revenue leakage through RCM data analysis.
Ensure accuracy and consistency of provider and practice data across EHR, credentialing, and payer systems.
Maintain and validate enrollment tables, matrices, and system configurations.
Review and optimize EHR rules to prevent credentialing and billing-related claim denials.
Collaborate cross-functionally to resolve data and workflow issues.
Develop reports and dashboards to track KPIs and revenue impact.
Document and share processes, system rules, and best practices.
Supports special projects requiring knowledge of delegated and non-delegated health plan requirements
Coordinate and prepare reports
Record and track credentialing statistics