Job Description
The Credentialing & Enrollment Specialist is responsible for all aspects of the credentialing, re-credentialing and privileging processes for all launching all providers in Privia’s high-performance medical group.
Primary Job Duties:
Ensure protocols are being followed to ensure timely resolution and completion of payor enrollment to ensure no loss of revenue due to untimely payor enrollment
Follows guidelines in alignment with all health plan requirements as related to the provider certification and credentialing.
Reviews and streamlines processes and workflows for the on-boarding department, using automation, where appropriate
Works with both internal and external stakeholders to resolve complex provider enrollment issues, including resolving claim denials related to provider enrollment
Supports special projects requiring knowledge of delegated and non-delegated health plan requirements
Interacts with varied levels of management, physician office staff and physicians effectively to accomplish credentialing and various elements of implementation and launch
Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.
Maintains confidentiality of provider information
Assist in managing the flow of information between the payers, contracted MSO facilities and PMG
Coordinate and prepare reports
Record and track credentialing statistics
Other duties as assigned.
Qualifications
2+ 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
Experience using Verity software preferred
Experience using Athena EMR preferred
Experience using Salesforce RCM preferred
Experience using Monday.com preferred
Interpersonal Skills & Attributes:
An individual with the ability to communicate appropriately and effectively with practitioners, internal stakeholders, and providers; including sensitive and confidential information
High level of attention to detail with exceptional organizational skills
Exercise independent judgment in interpreting guidelines of applicable regulatory bodies.
_ Colorado, New York, New Jersey, California and Washington Residents Only: The salary range for this role is $50,000.00-$60,000.00 in base pay and exclusive of any bonuses or benefits. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location._
Additional Information
All your information will be kept confidential according to EEO guidelines.
**Technical Requirements (for remote workers only, not applicable for onsite/in office work):**
In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests likehttps://www.speedtest.net/. This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.
Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. Privia is a better company when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age, color, national origin, physical or mental (dis)ability, race, religion, gender, sex, gender identity and/or expression, marital status, veteran status, or any other characteristic protected by federal, state or local law.