[Hiring] Provider Credentialing Specialist @Privia Health

Role Description

The Credentialing Specialist is responsible for all aspects of the credentialing, re-credentialing and privileging processes for all providers in Privia’s high-performance medical group.

• Follows documented process to ensure timely processing of Primary Source Verification completion for initial and recredentialing.
• Follows guidelines in alignment with all NCQA, CMS, and state requirements as related to the provider credentialing.
• Works with both internal and external stakeholders to resolve complex provider credentialing issues.
• Supports special projects requiring knowledge of delegated and non-delegated health plan requirements.
• Maintains up-to-date data (expireables) for each provider in credentialing databases and CAQH; ensures timely renewal of licenses, certifications, COI’s etc.
• Maintains confidentiality of provider information.
• Assist in managing the flow of information between internal stakeholders.
• Coordinate and prepare reports under the direction and supervision of the manager.
• Record and track credentialing statistics.
• Other duties as assigned.

Qualifications

• 1+ years experience in managed care credentialing Primary Source Verification.
• Demonstrated skills in problem solving and analysis and resolution.
• Must be able to function independently, possess demonstrated flexibility in multiple project management.
• Must comply with HIPAA rules and regulations.
• An individual with the ability to communicate appropriately and effectively with practitioners, internal stakeholders, and providers; including sensitive and confidential information.
• High level of attention to detail with exceptional organizational skills.

Requirements

• 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.

Benefits

• All your information will be kept confidential according to EEO guidelines.

Technical Requirements

• 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.

Company Description

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.