RCM Systems & Enrollment Analyst

RCM Systems & Enrollment Analyst is a critical role responsible for identifying analyzing and resolving conflicts and inconsistencies across revenue cycle management (RCM) and provider credentialing and enrollment processes. This individual will focus on preventing revenue leakage by ensuring data integrity across all systems validating system configurations and driving cross-departmental process improvements.

Primary Job Duties:

• Under the direction of the Senior Manager Athena Systems completes all EFT ERA EDI set up and enrollment with all health plans through claims system or payor portal.

• Conducts regular follow up with all health plans to obtain statuses of provider submissions.

• Works with other Privia partners is addressing any provider enrollment issues.

• Identify and resolve revenue leakage through RCM data analysis.

• Ensure accuracy and consistency of provider and practice data across EHR credentialing and payer systems.

• Maintain and validate enrollment tables matrices and system configurations.

• Review and optimize EHR rules to prevent credentialing and billing-related claim denials.

• Collaborate cross-functionally to resolve data and workflow issues.

• Develop reports and dashboards to track KPIs and revenue impact.

• Document and share processes system rules and best practices.

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

• Coordinate and prepare reports

• Record and track credentialing statistics

Qualifications :

• Bachelors degree in Healthcare Administration Finance Business or a related field preferred or equivalent work experience

• At least 3 years experience in managed care credentialing billing and/or Medical Staff service setting

• Demonstrated skills in problem solving and analysis and resolution

• Advanced Microsoft Excel skills

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

• Must comply with HIPAA rules and regulations

• Prefer knowledge of EFT ERA EDI enrollment and claims systems.

• Must have Athena system knowledge.

• Knowledge of Athena payer enrollment table strongly desired

The salary range for this role is $to $in base pay and exclusive of any bonus 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 10%. The 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. 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.  

Remote Work :

Yes

Employment Type :

Full-time