The Associate Director of Provider Enrollment provides strategic oversight and operational leadership to ensure the seamless integration of practitioners into Privia鈥檚 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鈥檚 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.