Manager, Payer Enrollment

Company Description

Privia Health™ is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.

Job Description

The 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. 

• Maintains 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.

Qualifications

• 5+ years’ experience in managed care credentialing, billing and/or Medical Staff service setting

• Demonstrated skills in problem solving, analysis and resolution

• 1+ years people management experience preferred 

• Intermediate/advanced Microsoft Excel skills required 

• Experience using Verity CredentialStream required 

• Athena EMR experience required 

• Experience supporting Medicare/Medicaid preferred

• Strong knowledge of NCQA guidelines & delegated payers preferred 

• 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.

The salary range for this role is $65,000 to $75,000 in base pay and exclusive of any bonuses or benefits. This role is also eligible for an annual bonus targeted at 15% and restricted stock units. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location. 

Additional Information

All of 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 like https://www.speedtest.net/. This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. 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.