Full-Time Credentialing & Enrollment Specialist

Credentialing & Enrollment Specialist

The Credentialing & Enrollment Specialist is responsible for all aspects of the credentialing, re-credentialing, and privileging processes for all providers in Privia’s high-performance medical group.

Primary Job Duties:

• Ensure protocols are followed to ensure timely resolution and completion of payor enrollment to prevent revenue loss due to untimely payor enrollment.
• Follow guidelines aligned with all health plan requirements related to provider certification and credentialing.
• Review and streamline processes and workflows for the onboarding 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 effectively with various levels of management, physician office staff, and physicians to accomplish credentialing and implementation tasks.
• 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 PMG.
• Coordinate and prepare reports.
• Record and track credentialing statistics.
• Other duties as assigned.

Requirements:

• 2+ years experience in managed care credentialing, billing, and/or Medical Staff service setting
• Knowledge of FL payers required
• Demonstrated skills in problem-solving and analysis
• Advanced Microsoft Excel skills required
• Ability to function independently and demonstrate flexibility in multiple project management
• Must comply with HIPAA rules and regulations
• Experience using Verity software preferred
• Experience using Athena EMR preferred
• Experience using Salesforce RCM preferred
• Experience using Monday.com preferred

Interpersonal Skills & Attributes:

• Excellent communication skills with practitioners, internal stakeholders, and providers, including sensitive and confidential information.
• High level of attention to detail and exceptional organizational skills.
• Ability to exercise independent judgment in interpreting guidelines of applicable regulatory bodies.

Salary: $45,000.00 - $55,000.00 (base pay)

Technical Requirements (Remote Workers Only):

Minimum internet speed requirements: Download 5 Mbps, Upload 3 Mbps. Use online speed tests (e.g., speedtest.net).

Benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs).

Eligible for an annual bonus (up to 10%).

EEO Statement: All information will be kept confidential according to EEO guidelines.

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