Travel: Hybrid on site 2 days a week minimum in our North Haven OfficeReporting to the VP, Population Health, the Manager, Credentialing & Enrollment is responsible for all aspects of the credentialing, re-credentialing, payer enrollment processes, data integrity and expirables for providers in Privia’s high performance medical group. This position is the primary liaison for credentialing and enrollment for assigned clinics, payers, billing office, and provider related issues. This position is a working manager responsible for the completion of all credentialing and enrollment tasks for their assigned market.Assures compliance with all health plan requirements as related to the provider certification, credentialing, and enrollment. Manages and monitors activities of the department to ensure compliance with all policies/procedures and regulationsFollows protocols to ensure timely resolution and completion of payer enrollment to ensure no loss of revenue to untimely payer enrollmentReviews and streamlines processes and workflows for the onboarding department, using automation, where appropriateWorks with technical staff to develop tools and procedures for auditing and reporting with the goal of streamlining credentialing and enrollment processes and communicating with company and external stakeholdersOversees special projects requiring knowledge of delegated and non-delegated health plan requirementsEnsures that NCQA standards are being followed in policies and proceduresProcesses credentialing files and ensures they are completed timely per KPIs/MetricsReviews monthly KPIs with associates to ensure they are meeting/exceeding goals by the 15th of each monthWorks closely with market implementation leaders to ensure smooth Go Lives for new groupsInteracts with varied levels of management, physician office staff and physicians effectively to accomplish credentialing and various elements of implementation and launchMaintain up-to-date data for each provider in credentialing and enrollment databases and online systems; ensure timely renewal of licenses and certifications. In addition, the Manager is responsible for all audits to ensure that delegated credentialing entities are compliantCoordinate and prepare reportsEnsures data integrity for all providersAssists in oversight and completion of all delegated auditsAssists with the data validation process for rostersRecord and track credentialing statisticsPerform other duties as assigned
