Provider & payer Enrollment Specialist (New Jersey)

Job Description

The Enrollment Specialist will be the primary contact for the New Jersey Market’s Enrollment Department for all Privia independent providers and care centers, and responsible for all aspects of managing the payer enrollment process. 

Primary Job Duties:

• The Enrollment Specialist will take steps necessary to enroll all new groups and providers with the contracted payers in the Florida market, including all commercial and federal payers.
• The Enrollment Specialist will manage all payer data in CredentialStream for both the group and the individual providers.
• The Enrollment Specialist will take steps necessary to investigate all claims/enrollment related issues or questions with the care centers.
• Work within AthenaOne EMR to resolve inbound claims related inquiries.
• Partners with internal and external partners in the onboarding process including the National Credentialing Team, Implementation Team, and Operations Consultants.
• Resolution of Salesforce cases and management of issues and the team resolving the cases is a key element in this role.
• Act as liaison between Enrollment Department and both internal and external stakeholders
• Other duties as assigned 

Qualifications

• 2+ years’ experience in payer enrollment function
• Verity CredentialStream or other credentialing experience preferred
• Familar with working in PECOs preferred 
• Experience working with providers & payers in New Jersey preferred
• Medicare/Medicaid payer experience required 
• Athena EMR experience preferred 
• 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

Interpersonal Skills & Attributes:

• An individual with the ability to communicate appropriately and effectively with  providers; including sensitive and confidential information
• An individual who is passionate about playing a key role in changing the current healthcare environment
• High level of attention to detail with exceptional organizational skills
• Exercise independent judgment
• Ability to problem solve and explore all options and to use available resources to find new and effective solutions

The salary range for this role is $50,000.00-$55,000.00 in base 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 10%. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

Additional Information

All 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 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.

Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. We understand that healthcare is local and we are better when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age, color, national origin, 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.