Sr. Payer Enrollment & Billing Specialist

Location: Hybrid, 2 days a week in our North Haven CT Office.

The  Sr. Payer Enrollment & Implementation Specialist is responsible for the AthenaOne payer 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.