Credentialing and Enrollment Specialist

4 weeks ago


Houston, Texas, United States Privia Health LLC Full time
Job Title: Credentialing and Enrollment Specialist

Join Privia Health LLC, a technology-driven, national physician enablement company, as a Credentialing and Enrollment Specialist. This full-time position is a hybrid role that requires working in the office on Tuesdays and Thursdays at 1200 Binz St Suite 1490 Houston TX, with the option to work from home on Mon, Wed, and Fri.

Job Summary:

The Credentialing and Enrollment Specialist is responsible for all aspects of the credentialing, re-credentialing, and privileging processes for all launching of all providers in Privia's high-performance medical group. This role requires strong analytical and problem-solving skills, with the ability to work independently and effectively communicate with internal and external stakeholders.

Key Responsibilities:
  • Ensure timely resolution and completion of payor enrollment to prevent loss of revenue.
  • Follow guidelines and align with all health plan requirements for provider certification and credentialing.
  • Review and streamline processes and workflows for the on-boarding department, utilizing automation where possible.
  • Work with internal and external stakeholders to resolve complex provider enrollment issues, including claim denials related to provider enrollment.
  • Support special projects requiring knowledge of delegated and non-delegated health plan requirements.
  • Maintain up-to-date data for each provider in credentialing databases and online systems, ensuring timely renewal of licenses and certifications.
  • Maintain confidentiality of provider information.
  • Assist in managing the flow of information between payers, contracted MSO facilities, and Privia Medical Group.
  • Coordinate and prepare reports, record, and track credentialing statistics.
Requirements:
  • At least 3 years' experience in managed care credentialing.
  • At least 2 years' experience in hospital credentialing and enrollment.
  • Experience with TX commercial and government payers required.
  • Provider enrollment experience required.
  • MS Excel (pivot table) proficiency required.
  • Verity CredentialStream experience preferred.
  • Salesforce experience preferred.
  • Athena EMR experience preferred.
  • Demonstrated skills in problem-solving and analysis and resolution.
  • Advanced Microsoft Excel skills.
  • Ability to function independently, possess demonstrated flexibility in multiple project management.
  • Ability to communicate effectively with practitioners, internal stakeholders, and providers, including sensitive and confidential information.
  • High level of attention to detail with exceptional organizational skills.
  • Ability to exercise independent judgment in interpreting guidelines of applicable regulatory bodies.
  • Compliance with HIPAA rules and regulations.
What We Offer:

Competitive salary range of $57,000 to $62,000 in base pay, with an annual bonus targeted at 10% based on performance in the role. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

Additional benefits include expense reimbursement for remote workers to offset internet costs and a commitment to creating a work environment that allows and encourages employees to bring their whole self to work.



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