Provider Credentialing Manager

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

Job Description

Reporting to the Director, Credentialing & Enrollment, the Credentialing Manager is responsible for all aspects of the credentialing, re-credentialing and privileging processes for all providers in Privia’s high performance medical group. 

Essential Functions:

• Assures compliance with all health plan requirements as related to the provider certification and credentialing. Manages and monitors activities of the department to ensure compliance with all policies/procedures and regulations
• Comprehensive knowledge of NCQA (or equivalent) standards in credentialing as well other state and regulatory licensure requirements
• Reviews and streamlines processes and workflows for the onboarding department, using automation, where appropriate
• 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
• Manages day to day activity of Credentialing Specialists
• 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. In addition, the Manager is responsible for all audits to ensure that delegated credentialing entities are compliant
• Assist in managing the flow of information between the payers, contracted MSO facilities and PMG.
• Coordinate and prepare reports
• Record and track credentialing statistics
• Perform other duties as assigned

Qualifications

• 5+ years’ experience in managed care credentialing, billing and/or Medical Staff service setting required
• People management experience preferred 
• 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

Interpersonal Skills & Attributes:

• Eager to embrace the challenges and opportunities to build a Credentialing department with in a rapidly growing start-up environment.
• An individual with the ability to communicate appropriately and effectively with practitioners and providers; including sensitive and …