Senior Payer Enrollment Specialist

4 weeks ago


New Haven, Connecticut, United States Privia Health Full time
Payer Enrollment Process Expert

Privia Health is seeking a highly skilled Payer Enrollment Process Expert to join our team. As a key member of our implementation team, you will be responsible for the athena payor enrollment process, including EDI, ERA, EFT payer registration, and working with clients to update PECOS and Medicaid accounts as needed.

Key Responsibilities:
  • Prepare presentations and communicate with clients regarding the roles and responsibilities of both Privia and the client during the implementation process.
  • Work closely with clients to establish or update EDI setup for athena.
  • Complete all worklist items/tasks in athena regarding EFT, ERA, EDI setup once the client has confirmed completion.
  • Assist clients with updates to the Medicare 855B group record, including EFT and pay, to address updates or implement a new Medicare 855B record as needed.
  • Provide weekly updates to key stakeholders on the athena payer enrollment table and bring to light any risks to the Go Live date.
  • Work in the claims system to identify any claims issues related to enrollment and work with local leaders to ensure resolution.
  • Update provider "PAR" statuses in athena to ensure claims will not hold when the CC goes live.
  • Work with other Privia partners, including RCM, credentialing, and operations, to address any provider enrollment issues.
  • Update claims systems and release claims on a regular basis.
  • Work Salesforce cases to provide updates to Care Centers on provider statuses.
  • Work with internal and external stakeholders to resolve complex Athena enrollment issues.
  • Support special projects requiring knowledge of athena.
  • Interact with varied levels of management, physician office staff, and physicians effectively to accomplish credentialing and various elements of implementation and launch.
  • Maintain confidentiality of provider information.
  • Coordinate and prepare reports.
Qualifications:
  • At least 2 years of experience in payer enrollment.
  • AthenaOne EMR experience required.
  • Medicare payer experience preferred.
  • Athena EDI setup experience preferred.
  • Ability to travel locally within the State of Connecticut.
  • Excellent client interaction skills.
  • Demonstrated skills in problem-solving and analysis and resolution.
  • Advanced Microsoft Excel skills.
  • Must be able to function independently and possess demonstrated flexibility in multiple project management.
  • Must comply with HIPAA rules and regulations.
  • Prefer knowledge of EFT, ERA enrollment, and claims systems.

Salary range: $55,000.00-$65,000.00 in base pay, exclusive of any bonuses or benefits. This role is also eligible for an annual bonus targeted at 10%.



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