Delegated Credentialing Specialist

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

The Delegated Credentialing Specialist is responsible for all aspects of the delegation and delegated contracts processes for all providers in Privia’s high-performance medical group.

Primary Job Duties:

• Assists with processing of all contracts between internal and external stakeholders providing regular updates on statuses of agreements.

• Works with health plans on audits for all delegated agreements including initial and annual audits.

• Works with health plans on mandatory credentialing activity reporting to ensure compliance with delegated agreements and NCQA CMS and state requirements.

• Reviews NCQA standards annually and ensures Privia’s Policies and Procedures align with standards under the direction of the Sr. Manager of Credentialing.

• Participates in the 3 year review for NCQA accreditation.

• Conducts 5% audit of files to ensure compliance with NCQA standards.

• Conducts annual system controls audits to ensure compliance with NCQA standards.

• 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 confidentiality of provider information.

• Assist in managing the flow of information between internal and external stakeholders.

• Coordinate and prepare reports under the direction and supervision of the manager.

• Record and track credentialing statistics.

• Other duties as assigned.

Qualifications

• 3+ years experience in credentialing audits and NCQA standards.

• 3+ years experience in credentialing function/file processing.

• 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

• Exercise independent judgment in interpreting guidelines of applicable regulatory bodies.

The salary range for this role is $55000.00- $60000.00 in base pay and exclusive of any bonuses or benefits. 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.

Additional Information

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. Privia is a better company 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.