Payer & Provider Enrollment Specialist

The Enrollment Specialist will be the primary contact for the Enrollment Department for Privia independent providers and responsible for all aspects of managing the payer enrollment process.

Primary Job Duties:

• Enrolls providers new to Privia with all commercial health plans specific to the market.
• Enrolls providers new to Privia with both Medicaid and Medicare.
• Updates and maintains provider enrollment status in credentialing system, CredentialStream.
• Reviews data in provider record, specifically taxonomy, license, and specialty and ensures it is correct prior to submitting applications.
• Performs follow up with health plans according to designated timeline, until Provider is PAR.
• Escalates known issues to manager for assistance.
• Collaborates with credentialing team regularly to ensure that there is an awareness of all new providers who are onboarding.
• Attends RCM and payer calls as needed as well as any other internal stakeholder meeting that may involve their market, as needed.
• Other duties as assigned.