Manager Payer Enrollment
Manager Payer Enrollment
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Salary Not Disclosed
1 Vacancy
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 onboarding 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 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.
- 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
- Experience leading Enrollment teams with large provider inventory
- Demonstrated skills in problem solving analysis and resolution
- Intermediate/advanced Microsoft Excel skills required
- Experience using Verity CredentialStream preferred
- Athena EMR experience preferred
- Experience supporting Medicare/Medicaid required
- 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 $65000 to $75000 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 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 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
- Restaurant Experience
- Customer Service
- Employee Evaluation
- Management Experience
- Math
- Employment & Labor Law
- Sanitation
- Leadership Experience
- P&L Management
- Mentoring
- Supervising Experience
- Restaurant Management
