Full-Time Payer Enrollment Manager

Privia Health is hiring a remote Full-Time Payer Enrollment Manager. The career level for this job opening is Manager and is accepting USA based applicants remotely. Read complete job description before applying.

Privia Health

Job Title

Payer Enrollment Manager

Posted

Career Level

Full-Time

Career Level

Manager

Locations Accepted

USA

Salary

YEAR $65000 - $75000

Job Details

Manager, Payer Enrollment is responsible for facilitating the enrollment program and serves as the primary enrollment liaison for clinics, payers, billing office, and practitioner related issues.

Primary Job Duties:

  • Ensure protocols are being followed to ensure timely resolution and completion of payor enrollment to ensure no loss of revenue due to untimely payor enrollment
  • Assures compliance with all health plan requirements as related to the provider certification and credentialing.
  • Reviews and streamlines processes and workflows for the on-boarding department, using automation, where appropriate.
  • Works with both internal and external stakeholders to provide regular updates and resolve complex provider enrollment status and/or issues, including resolving claim denials related to provider enrollment
  • Works with technical staff to develop tools and procedures for auditing and reporting with the goal of streamlining credentialing processes and communicating with company and external stakeholders
  • Oversees special projects requiring knowledge of delegated and non-delegated health plan requirements
  • Interacts 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.
  • Mentor and train new and existing staff.
  • Autonomously lead meetings with key internal and external stakeholders.
  • Assist in managing the flow of information between the payers, contracted MSO facilities and PMG
  • Coordinate and prepare reports
  • Record and track credentialing statistics
  • Other duties as assigned.

Experience:

  • 5+ years’ experience in managed care credentialing, billing and/or Medical Staff service setting
  • Experience leading Enrollment teams with large provider inventory

Skills:

  • Demonstrated skills in problem solving, analysis and resolution
  • Intermediate/advanced Microsoft Excel skills
  • Experience using Verity CredentialStream preferred
  • Athena EMR experience preferred
  • Experience supporting Medicare/Medicaid required
  • Strong knowledge of NCQA guidelines & delegated payers preferred

Other Requirements

  • Must be able to function independently, possess demonstrated flexibility in multiple project management
  • Must comply with HIPAA rules and regulations

Interpersonal Skills & Attributes:

  • An individual with the ability to communicate appropriately and effectively with practitioners, internal stakeholders, and providers; including sensitive and confidential information
  • High level of attention to detail with exceptional organizational skills
  • Exercise independent judgment in interpreting guidelines of applicable regulatory bodies.

FAQs

What is the last date for applying to the job?

The deadline to apply for Full-Time Payer Enrollment Manager at Privia Health is 8th of May 2025 . We consider jobs older than one month to have expired.

Which countries are accepted for this remote job?

This job accepts [ USA ] applicants. .

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