Payer & Provider Enrollment Specialist (Maryland Medicaid)

The Enrollment Specialist will be the primary contact for the Enrollment Department for all 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.
• Data enters "add to roster" date in CredentialStream.
• Data enters "submitted" and "mailed" dates in CredentialStream.
• Data enters "effective" date in CredentialStream.
• Reviews data in provider record, specifically taxonomy and specialty, and ensures it is correct prior to submitting applications.
• Performs follow up with health plans 30 days after submission and then biweekly thereafter until the 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.