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
The Recovery Specialist is responsible for the backend process of payer enrollment process.
Primary Job Duties:
- Under the direction of the Enrollment Director, 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 in the claims system to identify any claims issues related to enrollment.
- Attends regularly scheduled meetings with health plans and escalates issues as identified.
- Works with other Privia partners is addressing any provider enrollment issues.
- Updates credentialing system with provider effective dates.
- Update claims system and releases claims on a regular basis.
- Works SalesForce cases to provide updates to Care Centers on provider statuses.
- Provides backup support to the provider enrollment team and may be required to file applications with payors from time to time.
- 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 PMG
- Coordinate and prepare reports
- Record and track credentialing statistics
- Other duties as assigned.
Qualifications
- 2+ years experience in managed care credentialing, billing and/or Medical Staff service setting
- Experience with Verity CredentialStream or similiar credentialing technology
- 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
Interpersonal Skills & Attributes: - An individual with the ability to communicate appropriately and effectively with practitioners, internal stakeholders, and providers; including sensitive and confidential information
- High level of attention to detail with exceptional organizational skills
- Exercise independent judgment in interpreting guidelines of applicable regulatory bodies.
The salary range for this role is $50,000.00-$55,000.00 in base pay and exclusive of any bonuses or benefits. 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.
echnical 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.