Enrollment Specialist – CA Payer Experience

Enrollment Specialist – CA Payer Experience

Requirements

• 2+ years’ experience in payer enrollment function
• Medicare/Medicaid payer experience required
• Demonstrated skills in problem solving and analysis and resolution
• Must comply with HIPAA rules and regulations
• Must be able to function independently, possess demonstrated flexibility in multiple project management
• 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

Responsibilities

• 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.

Preferred Qualifications

• Delegated and Non Delegated payer enrollment experience (not required but preferred)
• Experience with RCM – Enrollment claim resolution
• Verity or other credentialing experience preferred
• Prior experience with California Payer Enrollment is highly desirable