Credentialing & Enrollment Specialist

*This full-time position is a hybrid role that requires working in the office on Tuesdays and Thursdays at 1200 Binz St Suite 1490 Houston TX 77004. Mon, Wed, and Fri are typically work from home but may be in office on occasion.*

The Credentialing and Enrollment Specialist is responsible for all aspects of the credentialing, re-credentialing and privileging processes for all launching of all providers in Privia’s high-performance medical group.

Primary Job Duties:

• Ensure protocols are being followed to ensure timely resolution and completion of payor enrollment to ensure no loss of revenue due to untimely payor enrollment

• 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 Privia Medical Group

• Coordinate and prepare reports

• Record and track credentialing statistics

• Other duties as assigned