Enrollment Specialist (CA Payer Experience)

Privia Health; United States; On-site; USD 54,000 - 60,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

401K

Paid Time Off

Wellness Programs

Annual Bonus

Job summary

An innovative healthcare organization is seeking an Enrollment Specialist to oversee the payer enrollment process for independent providers. In this role, you will be the primary contact for managing enrollments with commercial health plans, Medicaid, and Medicare. Your expertise will ensure that provider records are accurate and up-to-date, while also facilitating communication between various stakeholders. This position offers a unique opportunity to impact the healthcare landscape positively while working in a supportive environment that values diversity and inclusion. If you're passionate about healthcare and eager to make a difference, this role is for you.

Qualifications

• 2+ years of experience in payer enrollment function.
• Experience with Medicare/Medicaid payer enrollment is required.

Responsibilities

• Manage the payer enrollment process for new providers.
• Collaborate with the credentialing team to onboard new providers.

Skills

Payer Enrollment

Problem Solving

Organizational Skills

Communication Skills

Attention to Detail

Education

Bachelor's Degree

Tools

CredentialStream

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 independent providers and responsible for all aspects of managing the payer enrollment process.

Primary Job Duties

• Enrolls providers new to Privia with all commercial health plans specific to the market.
• Enrolls providers new to Privia with both Medicaid and Medicare.
• Data enters "add to roster" date in CredentialStream.
• Data enters "submitted" and "mailed" dates in CredentialStream.
• Data enters "effective" date in CredentialStream.
• Reviews data in provider record, specifically taxonomy and specialty, and ensures it is correct prior to submitting applications.
• Performs follow up with health plans 30 days after submission and then biweekly thereafter until the 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.

Qualifications

• 2+ years’ experience in payer enrollment function
• Delegated and Non Delegated payer enrollment experience (not required but preferred)
• Experience with RCM - Enrollment claim resolution
• Verity or other credentialing experience preferred
• Medicare/Medicaid payer experience required
• Prior experience with California Payer Enrollment is highly desirable
• 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
• An individual with the ability to communicate appropriately and effectively with providers; including sensitive and confidential information
• An individual who is passionate about playing a key role in changing the current healthcare environment
• High level of attention to detail with exceptional organizational skills
• Exercise independent judgment
• Ability to problem solve and explore all options and to use available resources to find new and effective solutions.

Interpersonal Skills & Attributes

• An individual with the ability to communicate appropriately and effectively with providers; including sensitive and confidential information
• An individual who is passionate about playing a key role in changing the current healthcare environment
• High level of attention to detail with exceptional organizational skills
• Exercise independent judgment
• Ability to problem solve and explore all options and to use available resources to find new and effective solutions.

The salary range for this role is $54,000.00 - $60,000.00 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: Associate

Employment type: Full-time

Job function: Other

Industries: Hospitals and Health Care