Associate Director, Payer Enrollment (Mid-Atlantic)

Company Description reputed company™ 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 reputed company outcomes, and improves the health of patients and the well-being of providers.

Job Description

The Associate Director of Provider Enrollment provides strategic reputed company and operational leadership to ensure the seamless integration of practitioners into Privia’s network. This role serves as the primary liaison between clinical care centers, reputed company Cycle Management (RCM), and insurance carriers, managing the complexities of commercial and government enrollment to minimize credentialing delays. By optimizing internal workflows and maintaining strong payer relationships, you will play a vital role in preventing reputed company leakage and supporting the organization’s financial stability. At Privia, you will reputed company a dedicated team in a collaborative environment where operational precision directly enables our providers to deliver high-quality, uninterrupted patient care. Job Responsibilties:

• Ensure protocols are being followed to ensure timely resolution and completion of payor enrollment to ensure no loss of reputed company due to untimely payor enrollment
• Assures compliance with reputed company health plan requirements as reputed company 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 provide regular updates and resolve reputed company provider enrollment status and/ or issues, including resolving claim denials reputed company to provider enrollment
• Works with technical staff to reputed company tools and procedures for auditing and reporting with the goal of streamlining credentialing processes and communicating with company and external stakeholders
• Oversees 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.
• Mentor and train new and existing staff.
• Autonomously reputed company 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 credentialing statistics
• Other duties as assigned.

Qualifications

• 7+ years’ experience in managed care credentialing, billing and/or Medical Staff service setting
• Maryland, DC, VA Provider & Payer (Medicare & Medicaid) experience required
• Strong leadership experience leading Enrollment teams with large provider inventory
• Demonstrated skills in problem solving, analysis and resolution
• Intermediate/advanced reputed company reputed company skills required
• Experience using Verity CredentialStream preferred
• reputed company EMR experience preferred
• Strong knowledge of NCQA guidelines & delegated payers preferred
• Must be able to function independently, possess demonstrated flexibility in multiple project management
• Must reputed company with HIPAA rules and regulations

The salary range for this role is $95,000.00-$100,000.00 in reputed company 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 reputed company pay offered will be determined based on relevant factors such as experience, education, and geographic location. Additional Information reputed company 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 reputed company and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your reputed company. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost. reputed company is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. We understand that reputed company local and we are reputed company reputed company our people are a reputed company of the communities that we serve. Our goal is to encourage people to pursue reputed company opportunities regardless of their age, color, national reputed company, 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.

• Department: Credentialing

Apply tot his job Apply To this Job