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Privia Health · 4 days ago

Sr. Payer Enrollment & Implementation Specialist

North Haven, CT

Full-time

Hybrid

Mid, Senior Level

$60K/yr - $68K/yr

2+ years exp

Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems. The Sr. Payer Enrollment & Implementation Specialist is responsible for managing the AthenaOne payer enrollment process, including EDI, ERA, and EFT payer registration, while ensuring effective communication with clients and stakeholders throughout the implementation process.

Health CareHospitalInformation TechnologyManagement Information SystemsMedicalOutpatient CareWellness

Growth Opportunities

Responsibilities

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

Qualification

Payer enrollmentAthenaOne EMREFT enrollmentMedicare payer experienceAthena EDI setupMS ExcelClient interactionHIPAA complianceProblem solvingProject management