Manager, Provider Enrollment
Manager, Provider Enrollment
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Salary Not Disclosed
1 Vacancy
Job Description
The Manager of Enrollment oversees the enrollment program and is the primary liaison for clinics payers the billing office and practitioners. This role ensures that all healthcare providers are accurately enrolled with various health plans including federal state marketplace and commercial options. The ideal candidate should have strong knowledge of operational processes credentialing and payer enrollment focusing on enhancing efficiency and ensuring smooth provider onboarding and enrollment operations.
- Lead all enrollment activities to ensure provider participation status
- Lead all demographic updates to ensure provider termination; demographic updates are submitted to payers and processed
- Ensure protocols are followed to ensure timely resolution completion of payor enrollment and no revenue loss due to untimely enrollment.
- Assures compliance with all health plan requirements related to the provider certification and credentialing.
- 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
- Collaborates with RCM leadership to identify enrollment issues affecting claims payments and develop an action plan to resolve them.
- Manages special projects that require understanding payer enrollment and its effects on claims processing.
- Interacts with varied levels of management physician office staff and physicians effectively to accomplish enrollment before implementation of new Care Center or Provider
- Maintain up-to-date data for each provider in credentialing databases internal tracking systems and Athena to ensure timely release of claims and notification to Care Center and providers of their enrollment status
- 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 enrollment statistics
- Other duties as assigned.
Qualifications :
- 5 years experience in managed care enrollment billing and/or Medical Staff service setting
- Experience with Texas Medicaid enrollment
- Excel
- Demonstrated skills in problem-solving analysis and resolution
- 5 years of people management experience preferred
- Intermediate/advanced Microsoft Excel skills required
- Experience using Verity CredentialStream preferred
- Athena EMR experience required
- Experience supporting Medicare/Medicaid preferred
- CAQH experience preferred
- 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 $68000.00 to $75000.00 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 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 :
Technical Requirements (for remote workers):
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.
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 :
Full-time
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
