Sr. Credentialing & Enrollment Specialist

Location: Hybrid, 2 days a week in our North Haven CT Office.The Sr. Payer Enrollment Specialist is responsible for the athena payor 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 launchMaintains confidentiality of provider informationCoordinate and prepare reportsOther duties as assigned.