Associate Director, Payer Enrollment NCQA

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.

Candidates living in/near Atlanta, GA preferred. The Associate Director of Provider Enrollment provides strategic oversight and operational leadership to ensure the seamless integration of practitioners into Privia’s 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’s 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.

• Ensure protocols are followed to resolve and complete payor enrollment to prevent loss of revenue due to untimely enrollment
• Assure compliance with all health plan requirements related to provider certification and credentialing
• Review and streamline processes and workflows for the onboarding department, using automation where appropriate
• Work with internal and external stakeholders to provide regular updates and resolve complex provider enrollment status and issues, including claim denials related to enrollment
• Work with technical staff to develop tools and procedures for auditing and reporting to streamline credentialing processes and communicate with internal and external stakeholders
• Oversee special projects requiring knowledge of delegated and non‑delegated health plan requirements
• Interact with varied levels of management, physician office staff, and physicians to accomplish credentialing and implementation and launch
• Maintain up‑to‑date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications
• Maintain 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 payers, contracted MSO facilities, and PMG
• Coordinate and prepare reports
• Record and track credentialing statistics
• Other duties as assigned

• 7+ years’ experience in managed care credentialing, billing and/or Medical Staff service setting
• Experience leading enrollment teams with large provider inventory
• Demonstrated problem‑solving, analysis and resolution skills
• Intermediate/advanced Microsoft Excel skills required
• Experience using Verity Credential Stream preferred
• Athena EMR experience preferred
• Experience supporting Medicare/Medicaid required
• Strong knowledge of NCQA guidelines & delegated payers preferred
• Must be able to function independently and display flexibility in multiple project management
• Must comply with HIPAA rules and regulations

Base pay: $95,000.00–$. The role is eligible for an annual bonus targeted at 15% and restricted stock units. Benefits include health, dental, vision, life, pet insurance, 401(k), paid time off, and other wellness programs.

All of your information will be kept confidential according to EEO guidelines.

Minimum 5 Mbps download speed and 3 Mbps upload speed. Employees working from home are eligible for expense reimbursement.

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 reflect the communities we serve. Our goal is to encourage people to pursue all opportunities regardless of age, color, national origin, physical or mental disability, race, religion, gender, sex, gender identity and expression, marital status, veteran status, or any other characteristic protected by federal, state or local law.