Credentialing and Enrollment Specialist

1 day ago

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

This is a hybrid role that requires working in the office on Tuesdays and Thursdays at 1200 Binz St Suite 1490 Houston TX. The remaining days are typically work from home but may be in office on occasion.

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.

Key Responsibilities:
  • Ensure timely resolution and completion of payor enrollment to prevent loss of revenue due to untimely payor enrollment.
  • Follow guidelines in alignment with all health plan requirements as related to provider certification and credentialing.
  • Review and streamline processes and workflows for the on-boarding department, using automation where appropriate.
  • Work with internal and external stakeholders to resolve complex provider enrollment issues, including resolving claim denials related to provider enrollment.
  • Support special projects requiring knowledge of delegated and non-delegated health plan requirements.
  • Interact with varied levels of management, physician office staff, and physicians effectively to accomplish credentialing and various elements of implementation and launch.
  • Maintain up-to-date data for each provider in credentialing databases and online systems; ensure 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.
  • Other duties as assigned.
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.
  • Must be able to function independently, possess demonstrated flexibility in multiple project management.
  • Must be able to communicate appropriately and effectively with practitioners, internal stakeholders, and providers; including sensitive and confidential information.
  • Must have a high level of attention to detail with exceptional organizational skills.
  • Must be able to exercise independent judgment in interpreting guidelines of applicable regulatory bodies.
  • Must comply with HIPAA rules and regulations.
Compensation:

The salary range for this role is $57,000 to $62,000 in base pay. This role is also eligible for 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 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. 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.

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