Payer & Provider 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.

About the role

The Enrollment Specialist will be the primary contact for the Enrollment Department for Privia independent providers and responsible for all aspects of managing the payer enrollment process.

Responsibilities

• Enrolls providers new to Privia with all commercial health plans specific to the market.
• Enrolls providers new to Privia with both Medicaid and Medicare.
• Updates and maintains provider enrollment status in credentialing system, CredentialStream.
• Reviews data in provider record, specifically taxonomy, license, and specialty and ensures it is correct prior to submitting applications.
• Performs follow up with health plans according to designated timeline, until Provider is PAR.
• Escalates known issues to manager for assistance.
• Collaborates with credentialing team regularly to ensure that there is an awareness of all new providers who are onboarding.
• Attends RCM and payer calls as needed as well as any other internal stakeholder meeting that may involve their market, as needed.
• Other duties as assigned.

Requirements

• 2+ years’ experience in payer enrollment function required
• Experience with RCM - enrollment claim resolution preferred
• Experience working in various payer portals required
• Verity CredentialStream or other credentialing software experience preferred
• Medicare/Medicaid payer experience required
• Demonstrated skills in problem solving and analysis and resolution
• Must be able to function independently, possess demonstrated flexibility in multiple project management
• Must comply with HIPAA rules and regulations

Pay

The salary range for this role is $50,000.00–$55,000.00 in base pay and is eligible for an annual bonus targeted at 10%. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

Benefits

• Medical, dental, and vision insurance
• Life and pet insurance
• 401K
• Paid time off
• Other wellness programs

Technical Requirements (for remote workers)

To successfully work remotely, we require a minimum of 5 MBPS for download speed and 3 MBPS for upload speed. This should be acquired prior to the start of employment. Use online speed tests like Speedtest to verify your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.