Provider & Payer Enrollment Specialist (New Jersey)

About the role

The Enrollment Specialist will be the primary contact for the New Jersey Market’s Enrollment Department for all Privia independent providers and care centers, and responsible for all aspects of managing the payer enrollment process.

Responsibilities

• Take steps necessary to enroll all new groups and providers with the contracted payers in the NJ market, including all commercial and federal payers.
• Manage all payer data in CredentialStream for both the group and the individual providers.
• Investigate all claims/enrollment related issues or questions with the care centers.
• Work within AthenaOne EMR to resolve inbound claims related inquiries.
• Partner with internal and external partners in the onboarding process including the National Credentialing Team, Implementation Team, and Operations Consultants.
• Resolve Salesforce cases and manage issues and the team resolving the cases is a key element in this role.
• Act as liaison between Enrollment Department and both internal and external stakeholders.

Qualifications

• 2+ years’ experience in payer enrollment function.
• Verity CredentialStream or other credentialing experience preferred.
• Familiar with working in PECOs preferred.
• Experience working with providers & payers in New Jersey preferred.
• Medicare/Medicaid payer experience required.
• Athena EMR experience preferred.
• 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.

Skills

• Interpersonal Skills & Attributes.

Benefits

The salary range for this role is $50,000.00-$55,000.00 in 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 10%.

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.