Manager, Payer Enrollment

Privia Health™ is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers

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 Manager of Enrollment oversees the enrollment program and is the primary liaison for clinics, payers, the billing office, and practitioners. This role ensures that all healthcare providers are accurately enrolled with various health plans, including federal, state, marketplace, and commercial options. The ideal candidate should have strong knowledge of operational processes, credentialing, and payer enrollment, focusing on enhancing efficiency and ensuring smooth provider onboarding and enrollment operations.

Job Duties:

• Lead all enrollment activities to ensure provider participation status
• Lead all demographic updates to ensure provider termination; demographic updates are submitted to payers and processed
• Ensure protocols are followed to ensure timely resolution, completion of payor enrollment, and no revenue loss due to untimely enrollment.
• Assures compliance with all health plan requirements related to the provider certification and credentialing.
• 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
• Collaborates with RCM leadership to identify enrollment issues affecting claims payments and develop an action plan to resolve them.
• Manages special projects that require understanding payer enrollment and its effects on claims processing.
• Interacts with varied levels of management, physician office staff, and physicians effectively to accomplish enrollment before implementation of new Care Center or Provider
• Maintain up-to-date data for each provider in credentialing databases, internal tracking systems, and Athena to ensure timely release of claims and notification to Care Center and providers of their enrollment status
• 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 enrollment statistics
• Other duties as assigned.

• 5+ years’ experience in managed care enrollment, billing, and/or Medical Staff service setting
• 5+ years of people management experience preferred
• Athena EMR experience required
• Experience with Texas Medicaid enrollment preferred 
• Experience supporting Medicare/Medicaid preferred
• Experience using Verity CredentialStream preferred
• CAQH experience preferred 
• Intermediate/advanced Microsoft Excel skills required - Pivot tables, VLOOKUP, etc. 
• Demonstrated skills in problem-solving, analysis, and resolution
• 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 $65,000 - $75,000 in base pay and exclusive of any bonuses or benefits This role is also eligible for an annual bonus targeted at 15%. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

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. Privia is a better company 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.