Credentialing Enrollment Specialist
Credentialing Enrollment Specialist
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
The Credentialing & Enrollment Specialist is responsible for all aspects of the credentialing recredentialing and privileging processes for all launching all providers in Privias highperformance medical group.
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
Follows guidelines in alignment with all health plan requirements as related to the provider certification and credentialing.
Reviews and streamlines processes and workflows for the onboarding department using automation where appropriate
Works with both internal and external stakeholders to resolve complex provider enrollment issues including resolving claim denials related to provider enrollment
Supports 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.
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
- Knowledge of FL payers required
- Demonstrated skills in problem solving and analysis and resolution
- Advanced Microsoft Excel skills required
- Must be able to function independently possess demonstrated flexibility in multiple project management Must comply with HIPAA rules and regulations
- Experience using Verity software preferred
- Experience using Athena EMR preferred
- Experience using Salesforce RCM preferred
- Experience using Monday preferred
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 $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
