Credentialing & Enrollment Specialist

Privia Health; United States; Remote; USD 45,000 - 55,000; Full time

Job summary

An innovative healthcare technology firm is seeking an Enrollment Specialist to drive the credentialing process for providers. This role is pivotal in ensuring compliance with health plan requirements and optimizing workflows for the onboarding department. You will collaborate with technical staff to develop tools for auditing and reporting, while also maintaining up-to-date provider data. This is a fantastic opportunity to join a forward-thinking company committed to enhancing patient experiences and improving healthcare delivery. If you have a passion for problem-solving and a strong background in managed care credentialing, this role could be your next big career move.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

401K

Paid Time Off

Wellness Programs

Expense Reimbursement for Home Office

Qualifications

• 2+ years’ experience in managed care credentialing and billing.
• Demonstrated skills in problem solving and project management.

Responsibilities

• Manage credentialing processes for providers in the medical group.
• Streamline workflows and ensure compliance with health plan requirements.

Skills

Problem Solving

Analysis and Resolution

Project Management

Education

2+ years in Managed Care Credentialing

Job description

Company Description

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.

Job Description

The Enrollment Specialist will be the primary contact for the Enrollment Department for all Privia credentialing, re-credentialing and privileging processes for launching all providers in Privia’s high performance medical group.

• Assures compliance with all health plan requirements as related to the provider certification and credentialing. Manages and monitors activities of the department to ensure compliance with all policies/procedures and regulations.
• Reviews and streamlines processes and workflows for the onboarding department, using automation where appropriate.
• 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.
• Interacts with varied levels of management, physician office staff, and physicians effectively to accomplish credentialing and various elements of implementation and launch.
• Maintains up-to-date data for each provider in credentialing databases and online systems; ensures timely renewal of licenses and certifications. In addition, the Credentialing and Enrollment Specialist is responsible for all audits to ensure that delegated credentialing entities are compliant.
• Maintains confidentiality of provider information.
• Assists in managing the flow of information between the payers, contracted MSO facilities, and PMG.
• Coordinates and prepares reports.
• Records and tracks 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.
• Must be able to function independently and possess demonstrated flexibility in multiple project management.
• Must comply with HIPAA rules and regulations.

The salary range for this role is $45,000.00 - $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.

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.

Seniority level

• Entry level

Employment type

• Full-time

Job function

• Information Technology
• Industries: Hospitals and Health Care