AVP, Credentialing & Payer Enrollment

The AVP, Credentialing and Payer Enrollment is responsible for leading a national team of individuals and is responsible for overseeing all aspects of the credentialing, re-credentialing, privileging, and payer enrollment processes for all providers in Privia’s high performance medical groups. In this role, relationship management and communication with Market Presidents, Market Operations, and Providers is a key success factor. Primary Job Duties: Oversee all aspects of Provider Credentialing and Payer Enrollment on a national level. Subject Matter Expert (SME) for all payer related matters and for reviewing payer or credentialing issues related to growth of the business, including researching and commenting on business development or market expansion credentialing matters. Work collaboratively with Payer Contracting, Revenue Cycle Management, Implementation, Performance Management, Finance, Compliance and other operational areas to ensure accurate information sharing, appropriate communication of any delays or other issues and complete reporting of performance and pertinent information for decision making. Lead the national team of credentialing resources to ensure consistency in hiring, training, onboarding and skill development. Maintain adequate resources to support the needs of the markets. Assure compliance with all government and health plan requirements as related to the provider certification and credentialing. Leads and monitors activities of the department to ensure compliance with all policies/procedures and regulations. Oversee the teams responsible for special projects requiring knowledge of delegated and non-delegated health plan requirements. Oversee the teams responsible for maintenance of the credentialing and enrollment software and reporting system. Oversee vendor relationships and assign appropriate work to vendors Develop leaders on the team. Create processes that maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications. Utilize Robotic Process Automation (RPA) to ensure scalability of the department. Maintain confidentiality of provider information. Manages the flow of information between the payers, contracted MSO facilities and Privia Medical Groups. Coordinate and prepare management and operational reports. Create and manage continual process and quality improvement efforts related to payer enrollment, data entry, credentialing committees and all aspects related to credentialing & enrollment. Design and review credentialing statistics that will drive improvement and hold people accountable for results. Ensure that the entire team is fully trained and able to work independently to the level of their role. Oversees all new athena tablespace builds on national level. Oversees and ensures that athena tablespaces are kept up to date. Other duties as assigned.