Sr. Managed Care Coordination Specialist

Privia Health

1d•$60,000 - $65,000

About The Position

The Sr. Managed Care Coordination Specialist plays a vital role in the organization's Credentialing and Provider Enrollment Department. This position is responsible for the timely and accurate preparation and submission of provider rosters to contracted health plans (payers) to ensure that all providers are appropriately paneled and able to bill for services. The role will work closely with the credentialing team, providers, internal stakeholders, care centers, and external health plan contacts to maintain compliance with all managed care contracts and regulatory requirements.

Requirements

5+ years in healthcare credentialing, provider enrollment, or managed care analysis.
Advanced Excel proficiency required. Candidates must be able to perform VLOOKUPs, pivot tables, and data cleaning for large datasets.
Familiarity with credentialing databases for data management, reporting, and tracking. Experience in CredentialStream preferred.
Deep understanding of CAQH, NPI, Availity and the provider enrollment lifecycle required
Experience in Salesforce case management system preferred

Nice To Haves

CPMSM, CPCS, or CPES certification through NAMSS preferred

Responsibilities

Lead the preparation and submission of comprehensive provider rosters to Managed Medicare, Medicaid, and commercial payers.
Data Reconciliation: Audit internal provider data (NPI, licenses, specialties, locations) against database records to ensure 100% accuracy before submission.
Manage all payer portal uploads and secure email submissions, maintaining a detailed log of submission dates and confirmation IDs.
Serve as the primary point of contact for health plans to resolve roster discrepancies, rejections, or paneling delays.
Maintain roster formats in accordance with individual payer requirements and regulatory standards.
Utilize internal databases to provide weekly status reports and analyze provider enrollment timelines for process improvement.
Partner with Revenue Cycle Management (RCM) to identify, troubleshoot, and resolve provider load issues causing claim denials or billing gaps.
Other duties, as assigned.