Associate Director, Payer Enrollment (Mid-Atlantic, NCQA)

The Associate Director of Provider Enrollment provides strategic oversight and operational leadership to ensure the seamless integration of practitioners into Privia’s network. This role serves as the primary liaison between clinical care centers, Revenue Cycle Management (RCM), and insurance carriers, managing the complexities of commercial and government enrollment to minimize credentialing delays. By optimizing internal workflows and maintaining strong payer relationships, you will play a vital role in preventing revenue leakage and supporting the organization’s financial stability. At Privia, you will lead a dedicated team in a collaborative environment where operational precision directly enables our providers to deliver high-quality, uninterrupted patient care.

Job Responsibilties:

• 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
• Assures compliance 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 provide regular updates and resolve complex provider enrollment status and/ or issues, including resolving claim denials related to provider enrollment
• Works with technical staff to develop tools and procedures for auditing and reporting with the goal of streamlining credentialing processes and communicating with company and external stakeholders
• Oversees 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.
• Mentor and train new and existing staff.
• Autonomously lead meetings with key internal and external stakeholders.
• Assist in managing the flow of information between the payers, contracted MSO facilities and PMG
• Coordinate and prepare reports
• Record and track credentialing statistics
• Other duties as assigned.

Qualifications

• 7+ years’ experience in managed care credentialing, billing and/or Medical Staff service setting
• Maryland, DC and/or VA Provider & Payer (Medicare & Medicaid) experience required 
• Strong leadership experience leading Enrollment teams with large provider inventory
• Demonstrated skills in problem solving, analysis and resolution
• Intermediate/advanced Microsoft Excel skills required
• Experience using Verity CredentialStream preferred
• Athena EMR experience preferred
• Strong knowledge of NCQA guidelines & delegated payers preferred
• Must be able to function independently, possess demonstrated flexibility in multiple project management
• Must comply with HIPAA rules and regulations

The salary range for this role is $95,000.00-$100,000.00 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 15% and restricted stock units. 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.