Sr. Payer Enrollment & Billing Specialist

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.

Location: Hybrid, 2 days a week in our North Haven CT Office.

The  Sr. Payer Enrollment & Implementation Specialist is responsible for the AthenaOne payer enrollment process which includes EDI, ERA, EFT payer registration and working with the client to update PECOS and Medicaid accounts, as needed.

• Prepares presentations and communicates to clients the roles and responsibilities of both Privia and the client during the implementation process with regard to Athena payer registration.
• Works closely with the client at their site to establish or update EDI set up for athena.
• Completes all worklist items/tasks in athena regarding EFT, ERA, EDI setup once client has confirmed completion.
• Assists the client with updates to the Medicare 855B group record that includes EFT and pay to address updates or assists in implementing a new Medicare 855B record, as needed.
• Provides weekly updates to all key stakeholders on athena payer enrollment table and brings to light any risk(s) to the Go Live date.
• Works in the claims system to identify any claims issues related to enrollment and works with local leaders to ensure this is resolved.
• Updates provider “PAR” statuses in athena so that claims will not hold when the CC goes live.
• Works with other Privia partners, including RCM, credentialing, and operations in addressing any provider enrollment issues.
• Update claims system and releases claims on a regular basis.
• Works SalesForce cases to provide updates to Care Centers on provider statuses.
• Works with both internal and external stakeholders to resolve complex Athena enrollment issues.
• Supports special projects requiring knowledge of athena.
• Interacts with varied levels of management, physician office staff and physicians effectively to accomplish credentialing and various elements of implementation and launch
• Maintains confidentiality of provider information
• Coordinate and prepare reports
• Other duties as assigned.

• 2+ years experience in payer enrollment & credentialing 
• AthenaOne EMR experience preferred
• Athena EDI set up experience preferred
• Knowledge of EFT, ERA, and EDI enrollment and claims systems preferred 
• Knowledge of PECOS for Medicare & Medicaid enrollment preferred
• Excellent client interaction skills
• Demonstrated skills in problem solving and analysis and resolution
• MS Excel skills (vlookup, pivot tables)
• Must be able to function independently, possess demonstrated flexibility in multiple project management
• Must comply with HIPAA rules and regulations
• Ability to travel locally within the state of Connecticut, as needed

The salary range for this role is $60,000 to $68,000 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%. 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. 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.