Full-Time Enrollment Specialist

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.

• 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.

Required Experience and Skills:

• 2+ years’ experience in payer enrollment function
• Delegated and Non Delegated payer enrollment experience (preferred)
• Experience with RCM - Enrollment claim resolution
• Verity or other credentialing experience (preferred)
• Medicare/Medicaid payer experience (required)
• Prior experience with California Payer Enrollment (highly desirable)
• 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
• Ability to communicate appropriately and effectively with providers, including sensitive and confidential information
• 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 use available resources to find new and effective solutions

Interpersonal Skills & Attributes:

• Strong communication skills with providers
• Strong attention to detail and organizational skills
• Ability to exercise independent judgment and problem solve

Salary Range: $54,000.00 - $60,000.00 (base pay)

Remote Work Requirements (if applicable):

• Minimum 5 MBPS download speed and 3 MBPS upload speed

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