Credentialing Enrollment Specialist
Credentialing Enrollment Specialist
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Salary Not Disclosed
1 Vacancy
Job Description
The Crentialing & Enrollment Specialist will be the primary contact for the Enrollment Department for all Priviacredentialing recredentialing and privileging processes for all launching all providers in Privias high performance medical group.
- Assures compliance with all health plan requirements as related to the provider certification and credentialing. Manages and monitors activities of the department to ensure compliance with all policies/procedures and regulations
- 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 processes and communicating with company and external stakeholders
- Oversees special projects requiring knowledge of delegated and nondelegated 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 uptodate data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications. In addition the Credentialing and enrollment specialist is responsible for all audits to ensure that delegated credentialing entities are compliant.
- Maintains confidentiality of provider information
- 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 :
- 2 years experience in managed care credentialing billing and/or Medical Staff service setting
- 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
The salary range for this role is $45000.00 $55000.00 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 base pay offered will be determined based on relevant factors such as experience education and geographic location.
Additional Information :
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 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.
Remote Work :
Yes
Employment Type :
Fulltime
Employment Type
Remote
Company Industry
Key Skills
- Sales Experience
- Crane
- Customer Service
- Communication skills
- Heavy Equipment Operation
- Microsoft Word
- Case Management
- OSHA
- Team Management
- Catheterization
- Microsoft Outlook Calendar
- EHS
