Payer & Provider Enrollment Specialist

Privia Health; Northern (KY); Hybrid; USD 50,000 - 55,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

Pet insurance

401K

Paid time off

Wellness programs

Annual bonus (10%)

Job summary

Privia Health is seeking an Enrollment Specialist to serve as the primary contact for the Enrollment Department for Privia independent providers and manage the payer enrollment process.

You will enroll providers with commercial plans, Medicaid, and Medicare, keep CredentialStream updated, review provider data, and coordinate with credentialing and RCM teams to meet timelines. Remote work options available.

Qualifications

• 2+ years’ experience in payer enrollment function.
• Experience with RCM - enrollment claim resolution preferred.
• Experience working in various payer portals.
• 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.

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 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.

Skills

Payer enrollment

RCM

Payer portals

HIPAA compliance

Tools

CredentialStream

Job 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 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.
• 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.

Qualifications

• 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

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.

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. We understand that healthcare is local and we are better 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.