Manager, Credentialing & Enrollment na Privia Health

Privia Health elevates the patient-provider relationship by delivering tools, talent, and technology built to transform healthcare. Our proven, physician-focused platform is designed to reduce unnecessary costs, achieve better outcomes, and improve patient health and provider well-being.

Travel: Hybrid on site 2 days a week minimum in our North Haven Office

Reporting to the VP, Population Health, the Manager, Credentialing & Enrollment is responsible for all aspects of the credentialing, re-credentialing, payer enrollment processes, data integrity and expirables for providers in Privia’s high performance medical group. This position is the primary liaison for credentialing and enrollment for assigned clinics, payers, billing office, and provider related issues. This position is a working manager responsible for the completion of all credentialing and enrollment tasks for their assigned market.

• Assures compliance with all health plan requirements as related to the provider certification, credentialing, and enrollment. Manages and monitors activities of the department to ensure compliance with all policies/procedures and regulations

• Follows protocols to ensure timely resolution and completion of payer enrollment to ensure no loss of revenue to untimely payer enrollment

• Reviews and streamlines processes and workflows for the onboarding department, using automation, where appropriate

• Works with technical staff to develop tools and procedures for auditing and reporting with the goal of streamlining credentialing and enrollment processes and communicating with company and external stakeholders

• Oversees special projects requiring knowledge of delegated and non-delegated health plan requirements

• Ensures that NCQA standards are being followed in policies and procedures

• Processes credentialing files and ensures they are completed timely per KPIs/Metrics

• Reviews monthly KPIs with associates to ensure they are meeting/exceeding goals by the 15th of each month

• Works closely with market implementation leaders to ensure smooth Go Lives for new groups

• 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 and enrollment databases and online systems; ensure timely renewal of licenses and certifications. In addition, the Manager is responsible for all audits to ensure that delegated credentialing entities are compliant

• Coordinate and prepare reports

• Ensures data integrity for all providers

• Assists in oversight and completion of all delegated audits

• Assists with the data validation process for rosters

• Record and track credentialing statistics

• Perform other duties as assigned

• 5+ years’ experience in managed care credentialing/enrollment, 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 strongly preferred

• Athena EMR experience preferred

• Experience supporting Medicare/Medicaid/Commercial Payers (State of Indiana preferred)

• Strong knowledge of NCQA guidelines & delegated payers

• Must be able to function independently, possess demonstrated flexibility in multiple project management

• Must comply with HIPAA rules and regulations

The salary range for this role is $70,000 to $80,000 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 15% & restricted stock units. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

All 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. We understand that healthcare is local and we are better 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.