Sr. Enrollment Specialist

Privia Health™ is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers

The Senior Enrollment Specialist is responsible for all aspects of the payer enrollment process as well as handling more complex enrollment issues in Privia's high performance Medical Group.

• Assigns files to associates based on state and ensures that new groups are PAR by Go Live date and individual providers are PAR by Go Live date.
• Works with manager to ensure follow up and documentation is being completed in the CredentialStream system.
• Handles more complex issues relating to government or commercial payers.
• Ensures protocols are being followed to ensure timely resolution and completion of enrollment process so that provider files can be approved within 60 days from the date of a completed application. Will escalate any issues for these protocols not being followed to Manager and Director.
• Attends JOCs with payers as required.
• Assures compliance with all policies and SOPs regarding timelines for submission.
• Reviews and streamlines processes and workflows for the onboarding department, using automation, where appropriate.
• Oversees the file inventory and assigns files to associates (based on existing files in process) to ensure timely completion of the credentialing process.
• Ensures all files are completed pursuant to the goal of 5 days from the date of approved credentialing, identifies issues, and escalates issues, as needed, to Manager and Director.
• Works with technical staff to develop tools and procedures for auditing and reporting with the goal of streamlining credentialing processes and communicating with company and external stakeholders
• Oversees special projects requiring knowledge of delegated and non-delegated health plan requirements.
• Troubleshoots issues with files/providers and is the first point of escalation for issues for the team.
• 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.
• Autonomously leads meetings with key internal and external stakeholders, including credentialing kick off calls with new care centers.
• 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.

• 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

The salary range for this role is $59,400 - $66,000 n base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 15% .The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

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 like https://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.