Enrollment Specialist - Remote

Overview

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 for this market.

In Short

• 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.

Requirements

• 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
• 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

Benefits

• Eligible for an annual bonus targeted at 10%
• Medical, dental, vision, life, and pet insurance
• 401K
• Paid time off
• Other wellness programs