Credentialing & Enrollment Specialist

Job Description

Job Description

Company Description

Privia Health™ is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.

Job Description

*This full-time position is a hybrid role that requires working in the office on Tuesdays and Thursdays at 1200 Binz St Suite 1490 Houston TX 77004. Mon, Wed, and Fri are typically work from home but may be in office on occasion.*

The Credentialing and Enrollment Specialist is responsible for all aspects of the credentialing, re-credentialing and privileging processes for all launching of all providers in Privia’s high-performance 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 on-boarding 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 non-delegated 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 up-to-date 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 Privia Medical Group

• Coordinate and prepare reports

• Record and track credentialing statistics

• Other duties as assigned

Qualifications

• At least 3 years' experience in managed care credentialing

• At least 2 years' experience in hospital credentialing & enrollment

• Experience with TX commercial & government payers required

• Provider enrollment experience required

• MS Excel (pivot table) proficiency required 

• Verity CredentialStream experience preferred 

• Salesforce experience preferred 

• Athena EMR experience preferred

• Demonstrated skills in problem solving and analysis and resolution

• Advanced Microsoft Excel skills or Google Sheets preferred

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

• Must be able to communicate appropriately and effectively with practitioners, internal stakeholders, and providers; including sensitive and confidential information 

• Must have a high level of attention to detail with exceptional organizational skills

• Must be able to exercise independent judgment in interpreting guidelines of applicable regulatory bodies.

• Must comply with HIPAA rules and regulations

The salary range for this role is $57,000 to $62,000 in base pay. This role is also eligible for an annual bonus targeted at 10% based on performance in the role. 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.

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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.