Sr. Credentialing & Enrollment Specialist at Privia Health

North Haven, Connecticut, United States -

Full Time

Start Date

Immediate

Expiry Date

09 Mar, 26

Salary

68000.0

Posted On

09 Dec, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Payer Enrollment, AthenaOne EMR, Medicare, EDI Setup, Client Interaction, Problem Solving, Microsoft Excel, Project Management, HIPAA Compliance, EFT Enrollment, Claims Systems, Provider Enrollment, Communication, Reporting, Confidentiality, Stakeholder Management

Industry

Hospitals and Health Care

Description

Company Description Privia Health™ is a national physician platform transforming the healthcare delivery experience. We provide tailored solutions for physicians and providers, creating value and securing their future. Through high-performance physician groups, accountable care organizations, and population health management programs, Privia works in partnership with health plans, health systems, and employers to better align reimbursements to quality and outcomes. Job Description Location: Hybrid, 2 days a week in our North Haven CT Office. The Sr. Payer Enrollment Specialist is responsible for the athena payor enrollment process which includes EDI, ERA, EFT payer registration and working with the client to update PECOS and Medicaid accounts, as needed. Prepares presentations and communicates to clients the roles and responsibilities of both Privia and the client during the implementation process with regard to Athena payer registration. Works closely with the client at their site to establish or update EDI set up for athena. Completes all worklist items/tasks in athena regarding EFT, ERA, EDI setup once client has confirmed completion. Assists the client with updates to the Medicare 855B group record that includes EFT and pay to address updates or assists in implementing a new Medicare 855B record, as needed. Provides weekly updates to all key stakeholders on athena payer enrollment table and brings to light any risk(s) to the Go Live date. Works in the claims system to identify any claims issues related to enrollment and works with local leaders to ensure this is resolved. Updates provider “PAR” statuses in athena so that claims will not hold when the CC goes live. Works with other Privia partners, including RCM, credentialing, and operations in addressing any provider enrollment issues. Update claims system and releases claims on a regular basis. Works SalesForce cases to provide updates to Care Centers on provider statuses. Works with both internal and external stakeholders to resolve complex Athena enrollment issues. Supports special projects requiring knowledge of athena. Interacts with varied levels of management, physician office staff and physicians effectively to accomplish credentialing and various elements of implementation and launch Maintains confidentiality of provider information Coordinate and prepare reports Other duties as assigned. Qualifications 2+ years experience in payer enrollment AthenaOne EMR experience required Medicare payer experience preferred Athena EDI set up experience preferred Ability to travel locally within the State of Connecticut Excellent client interaction skills 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 enrollment and claims systems The salary range for this role is $60,000 to $68,000 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%. 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 https://www.speedtest.net/. 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.

Responsibilities

The Sr. Credentialing & Enrollment Specialist is responsible for the athena payer enrollment process, including EDI, ERA, and EFT payer registration. They prepare presentations for clients and work closely with them to establish or update EDI setups and resolve claims issues.