The Senior Director, AI Innovation is a transformational leader responsible for partnering with senior leaders and defining, measuring, driving, and operationalizing the organization's AI and automation strategy, beginning within Revenue Cycle Management and then spreading throughout the organization. This role serves as the strategic connector between technology, operations, vendors, analytics, and RCM leadership to accelerate innovation, simplify complex workflows, reduce cost-to-collect, and improve both provider and patient financial experience.
The Senior Director, AI Innovation provides oversight of automation initiatives, including AI/ML models, RPA workflows, and advanced analytics ensuring they deliver measurable impact, scalability, and reliability. This leader builds and mentors a high-performing team that champions innovation, supports operational excellence, and drives continuous improvement across the organization, beginning with RCM.
Job responsibilities:
* Bachelor's degree in Business, Healthcare Administration, IT, or related field (Master's preferred).
* 10+ years of leadership experience in technology/innovation field, Revenue Cycle Management, or healthcare operations.
* Demonstrated success leading enterprise AI/ML, automation, or RPA initiatives at scale.
* Proven ability to collaborate with executive leadership and influence cross-functional teams.
* Strong understanding of healthcare billing, coding, claims processing, payer policies, and regulatory requirements.
* Experience managing complex vendor relationships and negotiating technology agreements.
* Must be able to critically evaluate data and make recommendations for change based on solid research and evidence.
* Proficiency in Microsoft Excel is required, along with strong analytical capabilities.
* Background in analytics, engineering, or process improvement preferred.
* Certification in Lean Six Sigma or project management preferred.
* Experience in a multi-state, multisite, or large-scale physician group environment preferred.
* Expand and execute the RCM AI and automation strategy, aligned with organizational priorities, regulatory requirements, and long-term growth objectives.
* Drive strategic alignment across executive leadership, IT, analytics, finance, and operational leaders to identify high-value innovation opportunities.
* Collaborate across departments with business stakeholders to identify, prioritize, and implement automation opportunities and workflow redesigns that maximize value.
* Serve as the thought leader on emerging technologies, vendor capabilities, and industry trends influencing the future of RCM. Continuing to stay current with the latest AI tech companies who are innovating in healthcare specific solutions across clinicals, Value Based Care (VBC), RCM, operations, customer experience, etc…
* Lead evaluation, selection, deployment, and optimization of AI/ML models to support RCM functions such as coding, prior auth, denials, predictive analytics, and patient engagement.
* Partner with Privia's AI governance committee to oversee that AI use cases and quality align with established expectations, ensuring ethical deployment, compliance, risk mitigation, and continuous monitoring of model performance.
* Partner with Analytics to define KPIs, insights, and dashboards to measure AI impact and forecast financial outcomes.
* Drive automation initiatives that reduce manual effort, improve accuracy, and support operating efficiency across RCM functions.
* Drive the comprehensive strategy, roadmap, and operational prioritization for RCM's Robotic Process Automation (RPA) initiatives.
* Oversee the operational testing and deployment readiness for new bots and bot updates.
* Establish and uphold rigorous controls to ensure the quality and effectiveness of automation through operational testing and prioritization.
* Establish SLAs, playbooks, and support frameworks to sustain automation tools post-implementation.
* Manage relationships with AI and automation vendors; negotiate contracts, evaluate performance, and ensure ROI delivery.
* Support vendors through the company's Third-Party Approval Committee (TPAC) process, ensuring all partners meet required standards for security, privacy, data governance, risk controls, and compliance before implementation.
* Collaborate with compliance, security, and legal teams to ensure ongoing adherence to organizational, regulatory, and contractual requirements.
* Implement structured frameworks for evaluating new ideas, testing solutions, and scaling successful pilots.
* Monitor and report on financial impact, operational KPIs and quality metrics.
* Ensure strong communication, transparency, and alignment with executive stakeholders.
* Lead and develop a team that supports RCM automation, vendor oversight, and system optimization efforts.
* Provide vision, prioritization, and direction for system enhancement work, RPA pipeline development, and operational support models, including coordination with offshore teams.
* Foster a culture focused on curiosity, continuous learning, disciplined execution, and measurable outcomes.
* Coach and mentor team members through goal setting, performance feedback, skills development, and professional growth pathways.
* Other job duties as assigned.
The salary range for this role is $140,000.00-$150,000.00 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 20% and restricted stock units. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.
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 *************************** 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. We understand that healthcare is local and we are better 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.
$140k-150k yearly 19h ago
Looking for a job?
Let Zippia find it for you.
Provider Recruitment Associate
Privia Health 4.5
Remote
Privia Healthâ„¢ 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
The Provider Recruitment Associate will support the growth of Privia Health by assisting the
Provider Recruitment team with the logistics of the recruitment process to result in the successful
placement of physician and advanced practitioner candidates within our care center practices
Develop and maintain working knowledge of our practice model and regional communities in order to assist with candidate inquiries
Work with physician recruiters to profile new requisitions and develop practice job descriptions
Work with physician recruiters to identify, source, pre-screen and schedule qualified candidates (APP's and Physicians) for further evaluation for open requisitions
Manage sourcing activities for all open requisitions and log activities in the applicant tracking system
Manage outbound communication campaigns, including broadcast emails, mailings, and other mass communications for physician and advanced practitioner requisitions
Provide support to Provider Recruitment Coordinator and physician recruiters with candidate interview processes, both telephone interview and site visit coordination, which may include arrangements for travel, lodging, etc.
Assist in the development and ordering of physician recruitment marketing collateral
Manage off-site recruitment events, such as regional and national conferences
Develop and maintain provider recruitment resource library
Continually develop upon processes, policies, and strategies to improve upon operations resulting in recruited providers
Delegate tasks to provider recruitment interns/contractors as necessary
Establish high reach objectives, personally track and report on performance
Other duties as assigned
Qualifications
Bachelor's Degree and at least one year related experience preferred
Previous healthcare sales or recruiting experience preferred
Strong computer technology skills including, but not limited to, Microsoft Outlook, Microsoft Word, Excel, PowerPoint, SalesForce and social media outlets
Superior marketing and public relations skills with the ability to communicate clearly and professionally to present practice opportunities in a positive manner
Proven track record of exceptional customer service skills
Demonstrated ability to conduct Internet research in an efficient, productive manner
Must comply with HIPAA rules and regulations
Excellent communication skills with the ability to engage at all levels of the organization. Demonstrate a professional and adaptable demeanor with internal and external clients, including administrators, physicians, peers, and support staff.
Exhibit a high energy level, and demonstrate the ability to work as a team, with flexibility in work habits to schedule and meet the needs of the medical staff.
Proven ability to multi-task, planning and prioritizing a large volume of detail-oriented work in accordance with changing deadlines.
The hourly range for this role is $20.00-$26.45 per hour and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for a commission based incentive plan between $10,000.00-$13,000.00. 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 *************************** 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. We understand that healthcare is local and we are better 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.
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 *************************** 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. We understand that healthcare is local and we are better 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.
$20-26.5 hourly 23d ago
Mental Health Administrative Assistant for California Applicants Only
Change Therapeutic Services Inc. 3.3
Highland, CA jobs
Job DescriptionBenefits:
Competitive salary
Flexible schedule
Paid time off
Benefits/Perks
Competitive Compensation
Paid Time Off
Career Growth Opportunities
Job Summary
Change Therapeutic Services, Inc. is a growing group psychiatry and therapy practice that provides compassionate, evidence-based mental health care for individuals, teens, and families. Our multidisciplinary team of psychiatrists, therapists, and nurse practitioners supports clients struggling with anxiety, depression, trauma, and relationship challenges. We are seeking a detail-oriented and empathetic Administrative Scheduler to join our team and help ensure a smooth and welcoming experience for our clients. The Administrative Scheduler plays a key role in coordinating appointments, managing client communication, and supporting the clinical team with administrative tasks. The ideal candidate is organized, tech-savvy, and comfortable communicating with clients in a calm, professional manner.
Responsibilities
Manage and maintain provider schedules across multiple locations
Schedule, confirm, and reschedule client appointments
Handle incoming calls, voicemails, and emails with professionalism and care
Verify client insurance information and assist with intake documentation
Support new client onboarding and send intake packets or forms as needed
Coordinate with clinical providers to ensure schedule accuracy
Maintain confidentiality and uphold HIPAA compliance at all times
Assist with other administrative duties as assigned (billing support, reminders, etc.)
Qualifications
12 years of administrative or scheduling experience (preferably in a healthcare or behavioral health setting)
Strong communication and organizational skills
Proficient with Google Workspace and electronic health record (EHR) systems (Simple Practice, or similar)
Compassionate, dependable, and able to multitask in a fast-paced environment
Knowledge of HIPAA standards preferred
Work Schedule & Compensation
The initial schedule is part-time, with full-time hours available per business needs
MondayFriday, flexible hours
Pay range: $16.50-$20.00, depending on experience
Opportunities for growth within the organization
This is a remote position.
$16.5-20 hourly 10d ago
Sr. Practice Operations Analyst
Privia Health 4.5
Remote
Privia Healthâ„¢ 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
We're seeking a Senior Analyst, Practice Operations to join our Analytics team, enabling physician leaders to make data driven decisions on financial, operational, and clinical opportunities. This person will be responsible for developing analyses, reports, models, and presentations for internal stakeholders as well as owners of Privia Medical Group practices.
Develop benchmark comparisons and financial models to project the economic impact of changes to practice staffing, patient access, productivity, payer mix, clinical quality, workflow, revenue cycle, etc.
Root cause analysis and opportunity identification to improve practice and market performance
Work directly with practices and market leaders to help prioritize and evaluate same-store growth opportunities
Utilize structured analytical thinking to synthesize valuable insights and present findings to physician executives, market presidents, and practice consultants
Discover, innovate, and implement process improvements to improve analytics team efficiency and scale analytic product solutions
Contribute to strategic plans to improve physician satisfaction, patient satisfaction, and practice profitability
Help to manage relations between IT, Product Engineering, and functional business areas for the delivery of technology solutions to stakeholders
Other duties as assigned
Qualifications
Bachelor's degree in business, operations, finance, STEM or related field preferred or equivalent experience.
4+ years' experience in healthcare consulting, strategy, or analytics with a focus on using data to drive operational change and insight, with a proven track record of driving ROI
3+ years of experience using SQL in large relational databases to query and cleanse data, with proven data validation processes
Experience optimizing the performance of a healthcare organization, preferably in Primary Care practice operations
Demonstrated proficiency in comprehensive financial statement analysis, including detailed P&L interpretation, Balance Sheet assessment, and the development of Pro-Forma models
Ability to think critically, applying analytical frameworks to complex business problems to synthesize insights
Able to remain flexible and responsive in fluid situations with simultaneous projects and to appropriately prioritize
Ability to establish and maintain collaborative relationships in high-pressure, fast-moving matrixed environments and motivate others to action
Excellent presentation skills with the ability to tailor the communication style to the audience, including analytics professionals, senior business leaders, physicians, and practice managers
Experience creating reports through BI tools, such as Tableau, Microstrategy, QlikView, and/or Looker
Support product development through design, build, and delivery of analytics-centric products
Must comply with HIPAA rules and regulations
The salary range for this role is $93,600.00 to $104,000.00 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs)
. This role is also eligible for an annual bonus targeted at 15% . 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 *************************** 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. We understand that healthcare is local and we are better 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.
$93.6k-104k yearly 23d ago
Virtual Clinic NP OR PA
Privia Health 4.5
Remote
Privia Healthâ„¢ 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 Virtual Clinic Nurse Practitioner OR Physician Assistant will be responsible for providing direct patient care in Privia's Virtual Clinic. Day-to-day, this role will be treating patients virtually through a HIPAA-compliant telehealth
platform and will support efforts in developing clinical protocols and virtual care guidelines along with
Privia's clinical leadership.We are looking for a board certified family medicine NP who is passionate
about transforming primary care, tech-savvy, experienced in delivering care through telehealth
modalities.
Treat patients via telemedicine using the technology platform through Privia Health including coordinating follow ups and managing tasks in the clinical inbox
Support the development of virtual care protocols, guidelines, policies, and training programs for providers
Participate in case reviews, consultations and utilization review
Participate in key virtual health strategy, business development, and clinical meetings
Stay current on telehealth issues and best practices
Perform other duties as assigned
Qualifications
Active NP OR PA required with Board Certification in Family Practice - ability to see pediatric and adult patients
Unrestricted license to practice medicine (VA, FL, TX, TN, GA, DC, CA, MT, and/or MD license(s) preferred)
Active NP OR PA required with Board Certification in Family Practice - ability to see pediatric and adult patients
3+ years of clinical practice in Family Medicine or Urgent Care setting
Weekend hours required, 1 Major Holiday per year, 1 Minor Holiday per year & 2 weekend shifts per month required
Prior experience delivering care through telehealth modalities
Must be able to meet Privia's credentialing requirements
Must be able to meet the credentialing requirements for Medicare, Medicaid, and other payers as necessary
Must be in good standing with medical boards and able to obtain additional state licensures
Must comply with HIPAA rules and regulations
Ability to work evenings, weekends, and holidays
Unparalleled ‘bedside manner' and ability to engage and empathize with patients
Passionate regarding the delivery of high-quality medical care
Desire to thrive in a fast-paced, high-growth, high-tech, brand-forward work environment
Ability to communicate information clearly and effectively, especially with other clinicians
Excellent analytical and problem-solving skills
Ability to work independently and with a team in a fast-paced and high-volume environment with an emphasis on accuracy and timeliness
The hourly pay for this role is $55-$60hr in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). 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 *************************** 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. We understand that healthcare is local and we are better 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.
$55-60 hourly 33d ago
Manager, Data Platform
Privia Health 4.5
Remote
Privia Healthâ„¢ 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 Manager, Data Platform will be responsible for projects involving our central data repository, cloud repository, and supporting operational data processes for the Privia Care Partners business line. This individual will work with key business stakeholders to define Privia Care Partners data needs, collaborate on these needs with the product management & engineering teams, and triage issues as they arise. This role has an opportunity to work with diverse stakeholders, including Privians supporting payer contracting, population health analytics, and medical economics, from requirements definition to launch and our vendor partners such as athena One.
Primary Job Duties:
Serve as a subject matter expert and product evangelist for data components of the Privia Care Partners' platform - primarily payer data management, non-Athena EMR data management, roster management and robotic process automation (RPA)
Provide outstanding relationship management and product support to physician practices and business stakeholders
Support and communicate with Product Management Team, especially with respect to escalated product support concerns and communication around product releases
Work collaboratively with stakeholders to develop strategies to provide better data timeliness and completeness for Privia's non-Athena practices
Understand incoming product requests, work with appropriate internal teams to prioritize appropriately and manage stakeholder expectations
Develop and maintain product roadmaps, quarterly goals, project plans, and other planning documentation
Track all projects on detailed timelines to meet deadlines and work with the Product Management team throughout the product lifecycle including scope definitions, roadmaps, use cases, requirements, and testing.
Verify product meets the business needs
Maintain existing projects, including ensuring products are meeting the agreed upon Service Level Agreement (SLA)
Support and create user documentation and training materials
Qualifications
Strong technical skills - not a developer, but is able to investigate technical issues including strong competency in SQL and other database concepts
2+ years of prior requirements analysis experience, working directly with stakeholders, or 2+ years combined requirements analysis and data engineering, analytics, technical writing, or similar experience
Bachelor's Degree required
Willing and able to solve problems without depending on others
Able to describe typical sources of healthcare data
Must comply with HIPAA rules and regulations
Demonstrated ability to manage projects independently
Demonstrated ability to use technical support and operational data, such as support cases, reports, and ad hoc investigations, to identify, triage, and document the impact, priority, and resolution of a problem.
Interpersonal skills & Attributes
Ability to work in a geographically distributed team
Willingness to accept input from anyone on the team
Eagerness to learn new skills and frameworks, as necessary
Ability to manage multiple priorities in a fast-paced, dynamic environment
Strong attention to detail
Ability to follow and enforce processes
Strong problem-solving skills
Excellent written and verbal communication skills
Ability to work and thrive in a collaborative team environment
Adaptable and flexible
The salary range for this role is $85,000.00 to $100,000.00 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 15% and restricted stock units. . 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 *************************** 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. We understand that healthcare is local and we are better 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.
$85k-100k yearly 24d ago
Identity Developer
Privia Health 4.5
Remote
Overview of the Role: Reporting to the Director of Identity Management and Assurance, the IAM Engineer plays a critical role in the design, implementation, and continuous development of Privia's identity platforms, with primary emphasis on our customer identity and access management (CIAM) ecosystem built on Ping One Advanced Identity Cloud (ForgeRock) and secondary emphasis on SailPoint IdentityNow for workforce identity governance.
This role ensures the CIAM and IGA platforms meet Privia's identity, security, and compliance needs. The IAM Engineer develops and maintains processes for authentication, authorization, governance, maintenance, and termination of user access for both workforce and non-workforce identities.
This position collaborates across departments to identify security gaps, optimize user lifecycle workflows, and strengthen overall identity posture. The IAM Engineer integrates the identity stack with systems such as Google Workspace, Workday, and other mission- and business-critical applications. They work with technical teams and business stakeholders to ensure identity workflows comply with security policies, industry standards, and best practices.
* Manage and perform onboarding integrations within SailPoint IdentityNow, ensuring provisioning and governance across multi-tiered enterprise applications.
* Serve as the technical project manager for IGA and CIAM implementation and expansion, overseeing deployment, upgrades, and continuous improvements.
* Develop and implement identity lifecycle management automations using scripting languages and APIs to streamline access provisioning and deprovisioning.
* Provide technical leadership and mentor Junior IAM engineers and other colleagues to maintain and enhance the IGA platform, ensuring scalability and security.
* Lead the design, development, and implementation of CIAM solution, namely Ping/Forgerock, collaborating with other engineers to enhance authentication and access management for external identities.
* Create and maintain multi-tiered technical documentation for IGA/CIAM processes and integrations to ensure clarity and compliance.
* Work cross-functionally with Cybersecurity, Compliance, IT, and Enterprise Application teams to align IAM/IGA initiatives with organizational security and business goals.
* 5+ years of experience designing and building complex IAM/IGA/CIAM implementations.
* 5+ years of hands-on experience with Ping Identity/ForgeRock in a CIAM engineering or architecture capacity.
* 3+ years of hands-on experience with SailPoint IdentityNow, including configuration and management.
* 5+ years of experience in user provisioning and lifecycle management, with a strong engineering perspective on designing and automating identity solutions.
* Experience integrating Workday with IAM, CIAM, or IGA systems, including lifecycle event automation derived from Workday data.
* Strong security skills across CIAM, IAM, and IGA domains.
* Must adhere to all HIPAA rules and regulations.
* Bachelor's Degree in Computer Science or a related field preferred.
CLOUD/SAAS
* Experience with user provisioning in cloud environments such as Google Workspace and Google Identity; familiarity with Google Cloud Platform is preferred.
* Strong understanding of access controls, authentication, and authorization models in cloud-based platforms.
* Experience working with Workday as a source of truth, including ingesting identity attributes, supporting hire/term data flows, and integrating Workday with an IGA platform for automated lifecycle management.
APPLICATION (Applications, Database, Interfaces)
* Understanding of securing a three-tier application architecture in the context of identity and access management.
* Knowledge of cloud-based security architecture, including multi-cloud environments and the differences between cloud-native applications and virtualized environments such as Citrix or VDI.
* Must have advanced experience with Ping Identity (ForgeRock) as a CIAM platform, including design, configuration, implementation, and integration.
* Experience with SailPoint IdentityNow strongly preferred as a supporting IGA platform for workforce lifecycle governance.
* Familiarity with Workday business processes, organizational structure, and worker data models to enable accurate identity creation, attribute mapping, and downstream provisioning.
AUTOMATION/SCRIPTING/INTEGRATION
* Experience with automation and scripting tools such as GAM (Google Apps Manager), Google Apps Script, Python, PowerShell, JavaScript, and other relevant languages to support identity lifecycle management.
* Proficiency in REST and SCIM APIs for automating user provisioning, deprovisioning, and access management across IAM, IGA, and CIAM solutions.
* Strong focus on automation, streamlining IAM processes, and identifying integration opportunities to enhance security and efficiency.
IGA/IAM/CIAM/PAM
* Must have expertise in designing and implementing Ping Identity (ForgeRock), including authentication flows, customer identity lifecycle management, consent, and federation.
* Extensive experience with Identity Governance and Administration platforms, particularly SailPoint IdentityNow, including RBAC, ABAC, access certifications, and automated provisioning workflows.
* Proven ability to integrate CIAM/IAM/IGA solutions with SSO protocols such as SAML, OAuth, and OpenID Connect to enhance security while improving user experience.
* Strong background in defining and enforcing IAM policies, implementing fine-grained access controls, and managing identity lifecycle events (Joiner, Mover, Leaver) in enterprise environments.
* Skilled in leading IAM architecture discussions, providing strategic technical guidance, and driving best practices across complex SaaS and cloud ecosystems.
EHR/EMR (Preferred)
* Experience with application support for an EHR/EMR - athena One preferred.
* Knowledge in the creation, modification, and termination of user profiles within an EHR/EMR application.
Minimum Qualifications:
* 5+ years of experience designing and building complex IAM/IGA/CIAM implementations.
* 5+ years of hands-on experience with Ping Identity/ForgeRock in a CIAM engineering or architecture capacity.
* 3+ years of hands-on experience with SailPoint IdentityNow, including configuration and management.
* 5+ years of experience in user provisioning and lifecycle management, with a strong engineering perspective on designing and automating identity solutions.
* Experience integrating Workday with IAM, CIAM, or IGA systems, including lifecycle event automation derived from Workday data.
* Strong security skills across CIAM, IAM, and IGA domains.
* Must adhere to all HIPAA rules and regulations.
The salary range for this role is $112,000.00 to $125,000.00 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 15% . The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.
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 *************************** 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. We understand that healthcare is local and we are better 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.
The Enrollment Specialist will be the primary contact for the Enrollment Department for all Privia independent providers and responsible for all aspects of managing the payer enrollment process. * Enrolls providers new to Privia with all commercial health plans specific to the market.
* Enrolls providers new to Privia with both Medicaid and Medicare.
* Data enters "add to roster" date in CredentialStream.
* Data enters "submitted" and "mailed" dates in CredentialStream.
* Data enters "effective" date in CredentialStream.
* Reviews data in provider record, specifically taxonomy and specialty, and ensures it is correct prior to submitting applications.
* Performs follow up with health plans 30 days after submission and then biweekly thereafter until the provider is PAR.
* Escalates known issues to manager for assistance.
* Collaborates with credentialing team regularly to ensure that there is an awareness of all new providers who are onboarding.
* Attends RCM and payer calls as needed as well as any other internal stakeholder meeting that may involve their market, as needed.
* Other duties as assigned.
* 2+ years' experience in payer enrollment function required
* Experience with RCM - Enrollment claim resolution preferred
* Experience working in various payer portals required
* Verity CredentialStream or other credentialing software experience preferred
* Medicare/Medicaid payer experience required, Maryland Medicaid experience preferred
* 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
Interpersonal Skills & Attributes:
* An individual with the ability to communicate appropriately and effectively with providers; including sensitive and confidential information
* An individual who is passionate about playing a key role in changing the current healthcare environment
* High level of attention to detail with exceptional organizational skills
* Exercise independent judgment
* Ability to problem solve and explore all options and to use available resources to find new and effective solutions
The salary range for this role is $50,000.00-$55,000.00 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). 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.
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 *************************** 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. We understand that healthcare is local and we are better 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.
$50k-55k yearly 19h ago
Revenue Integrity Specialist
Privia Health 4.5
Remote
Privia Healthâ„¢ 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
Under the direction of the Manager, Revenue Integrity and/or Sr. Director, Revenue Optimization the Revenue Integrity Specialist is responsible for complete, accurate and timely processing of reimbursement/payment audits in compliance with Privia policies, payer contracts and government fee schedules. In addition, the Revenue Integrity Specialist is also responsible for addressing requests for Care Center payment performance audits to assist in maximizing cash flow, as well as, tracking and reporting the outcomes of both standard payer audits and requested Care Center audits. This position works collaboratively with our operations consultants, RCM AR staff and management.
Primary Job Duties:
- Reimbursement Audits: Conduct audits of payer processed claims to verify accurate reimbursement per payer contract agreements, government, and state rates.
- Care Center Implementation Audits: Conduct post-implementation Care Center audits following the audit policy based on the number of providers on a 30/60/90/120 day schedule.
- Strategic Initiatives: Assist the Manager, RI, in leading initiatives that drive efficiency and partnering internally and externally to deliver expected results (e.g., monthly market meetings with leadership, internal team meetings, and meetings with top commercial payers).
- Decision Making & Communication: Make independent decisions regarding audit results and communicate these findings with appropriate teams, including contract negotiators, senior leaders, market leaders, and/or payers to ensure optimal revenue opportunity.
- Escalation Management: Create, follow, and ensure adherence to approved escalation processes for timely issue resolution and completion of action plans.
- Denial Management: Identify, monitor, and manage denial management trends. This includes working closely with Revenue Cycle Teams and payer representatives, and creating one-pagers/reference tools on payer policies.
- System Support: Assist with Trizetto/Cognizant setup and fee schedule setup.
- Operational Support: Work and address Salesforce cases along with AthenaOne tables.
- Miscellaneous: Perform other duties as assigned, focused on key performance and department goals.
Qualifications
High School Graduate preferred
Advanced Microsoft Excel skills (ex: pivot table, VLOOKUP, sort/filtering and formulas)
3+ years payer contracts (language) and/or auditing payer payments
Must be analytical, identify payment variance due to contract build or process errors, resolve payment issues, track & analyze payer information/policies.
Experience working in Trizetto EOB resolve tool or equivalent use of contract management/software
3+ years of experience in a medical billing office preferred
athena One software system experience is preferred
Must comply with HIPAA rules and regulations
The salary range for this role is $55,000.00-$60,000.00 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). 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 of 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 *************************** 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. We understand that healthcare is local and we are better 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.
$55k-60k yearly 4d ago
Care Advice Line RN I
Privia Health 4.5
Remote
We are actively recruiting for an RN New Grad Intern for our remote Care Advice Line, (CAL RN1) to join our rapidly growing Population Health team. The primary role of the CAL RN1 will be to provide our patients with on-demand telephone-based care management services through a 24/7 Nurse Advice Line (i.e. telephone triage). CAL RN1's will work closely with, and be mentored by senior nureses to assess symptoms/concerns of callers to determine the urgency and type of care needed, refer to or schedule appointments with providers as appropriate, and give health information and advice to callers. The goal of the Nurse Advice Line is to reduce unnecessary visits to the clinic and emergency department, provide information for self-care and symptom management, and to coordinate care across the healthcare delivery system. CAL RN1 operate in a team-based model, acting as an extension of the primary care provider.
* Handle inbound calls from patients and caregivers, providing compassionate and informed triage. • Conduct outbound communications for follow-up and care coordination with multiple healthcare providers and settings.
* Consult and coordinate with internal and external team members to assess, plan, implement, and evaluate patient care plans, make appropriate referrals, and provide follow-up as necessary. • Assist with finding appropriate providers, community resources, and care solutions and coordinate priority virtual appointments.
* Record member data in Privia's web-based medical record system and associated EMRs, and/or health portals.
* Maintain accurate patient records in Privia's systems and associated EMRs.
* Research information online and in Privia's internal knowledge databases to make the most appropriate triage and care advice decisions.
* Provide health information, coaching, and critical thinking skills to assist our members with medical and wellness-related issues.
* Accepts feedback and quality improvement initiatives constructively and enthusiastically. • Other care management activities, and duties as assigned and needed (e.g. close "gaps in care," complex care plans, etc.)
* Must comply with HIPAA rules and regulations at all times.
* Perform other duties as assigned
* 1+ years of RN experience in adult primary care and/or pediatric care in office, clinic, military, home, urgent care or hospital setting.
* Associate's degree in Nursing (BSN preferred or willingness to obtain within 24 months). •
* Nursing program transcripts showing a passing grade in Microbiology with Lab.
* Compact Resident RN in good standing, with the ability to apply to non-compact states as needed (expenses reimbursed).
* Availability to work 10-30 hours per week, including at least 10 hours on weekends (3 out of 4) and every 3rd holiday. Shifts are flexible and include 2, 4, 8, & 12-hour options.
* Exceptional customer service skills.
* Strong computer and tech skills.
* Excellent communication and listening skills.
* Clear, confident communication and listening skills.
* Self -motivated and self-disciplined a must.
* Willingness to do what it takes to get the job done and make patients, parents and providers the number one priority.
* Able to thrive in a quiet, secure home office environment.
* Detail-oriented and organized.
The hourly pay for this role is $25-30hr in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.
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 *************************** 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. We understand that healthcare is local and we are better 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.
$25-30 hourly 48d ago
Corporate Development Director
Privia Health 4.5
Remote
We are looking for an experienced Associate Director, Corporate Development to be responsible for a wide range of strategic finance activities. You'll play a critical role on Privia's finance team in an exciting growth phase of the company. You'll develop a deep understanding of our business and operating models, and support our senior management team through financial analyses and forecasts. You'll report to the SVP, Corporate Strategy and Finance, and work closely with our SVP and VP of Business Development, and collaborate with teams across the broader organization, including legal, operations, FP&A, sales and others.
Business Development (75%)
* Evaluate potential opportunities for growth and development, including: partnerships, acquisitions and investments
* Lead engagements on financial and operational due diligence, including acquiring financial data from practice management systems to develop models and analyses
* Develop financial forecast models during due diligence, including critical value proposition for partners, based on robust analyses of market growth potential, revenue / cost drivers and synergies
* Build business cases for new market opportunities, including scoping and market segmentation
* Assist in managing cross-functional efforts from end-to-end for business development deals
* Lead post-deal integration efforts to manage transition of a deal post-close
* Project manage a variety of initiatives and cross-functional stakeholder communication through regular meetings, status updates, and other communications, to ensure business development initiatives are on-track and successful
Strategic Finance (25%)
* Develop and manage project plans for strategic initiatives, including timelines, milestones, and resource requirements. Collaborate with cross-functional teams to ensure successful execution
* Conduct market, competitor, and customer analyses and develop business cases for new services
* Analyze complex data sets paired with partner team feedback to provide insights and recommendations to leadership
* Ad-hoc business projects and financial modeling analyses
* 3+ years experience working in investment banking, equity research, corporate development, corporate finance or equivalent
* Strong attention to detail with advanced financial modeling skills
* Bachelor's degree with a major in economics, finance, or another quantitative subject preferred
* Proactive willingness to go the extra mile
* Strong team player who is proactive, responsive and can thrive in a fast-paced, collaborative environment
* Ability to work both independently and cooperatively, handling multiple projects and adhering to deadlines with strong time management skills
* Exceptional communication skills at all levels and ability to convey technical topics to non-technical audiences
* Resourceful and can engage other teams and resources to figure out answers to nebulous questions
* Must possess a 'can-do' attitude with the ability to work well with all levels of internal management and staff
The salary range for this role is $105,000 to $130,000 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 15% & restricted stock units. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.
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 *************************** 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. We understand that healthcare is local and we are better 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.
$105k-130k yearly 19h ago
Payer Contracting Analyst
Privia Health 4.5
Remote
The Payer Contracting Analyst is a key contributor on our Payer Contracting team in enabling both the team and other departments to make better data driven decisions on financial, operational, and clinical initiatives. This position will play a key supporting role in the development, analysis, and optimization of
commercial and government payer contracts within the organization. This role covers internal and external
customers and requires working cross-functionally to understand evolving business needs and
requirements. This Privia Partner will be responsible for helping to design and develop reports,
presentations, and models to guide strategic decision making of our stakeholders. The Analyst works to
deliver data-driven insights to key stakeholders across the enterprise. The Analyst assists in the
development of end-to-end analytics solutions efforts, working with cross-functional teams to deliver on
evolving requirements and business needs, build scalable reports and applications, and deliver solutions
that ultimately empower end-users in making data-driven business decisions. The Analyst also supports the
execution of business- and client-facing ad hoc analyses, using data to guide strategic discussions among
and between internal and external stakeholders.
* Conduct quantitative analyses to evaluate payer performance, utilization trends, cost drivers, and reimbursement outcomes.
* Develop insights that support contract strategies, rate negotiations, and value-based care program underwriting.
* Responsible for assessing legal and financial implications of all contracting opportunities, including new contacts, contractual amendments and assignments to existing contracts.
* Build and maintain fee schedule models to forecast expected reimbursement under various contract terms.
* Perform scenario analysis and assess financial impacts of proposed rate changes, proposals, or contract structures.
* Assist in the development of value-based care financial models, including shared savings, bundled payments, quality incentive programs, and care coordination fees.
* Support ongoing monitoring of value-based program performance and emerging opportunities.
* Write SQL queries to extract and analyze medical claims data.
* Develop standardized reports and dashboards used for internal reviews and external payer discussions.
* Ensure data accuracy, completeness, and consistency across analytical deliverables.
* Work closely with the Payer Contracting team to translate analytical findings into compelling
* insights that inform negotiation strategy.
* Collaborate with our Revenue Optimization and Payer Contracting teams to develop reports and alerts that will ensure that Privia is being paid appropriately for fee-for-service andpay-for-performance contracts.
* Partner with Finance, Population Health, Revenue Cycle, and Clinical Operations teams as needed.
* Bachelor's degree in a quantitative field (e.g., Economics, Finance, Statistics, Mathematics, Computer Science) or equivalent professional experience; healthcare environment experience preferred.
* Experience using SQL
* Strong Microsoft Excel skills, including pivot tables and advanced formulas
* 1+ years experience working with healthcare claims data preferred
* Strong project management and analytical skills, including a desire to logically solve business andtechnology problems
* Must comply with HIPAA rules and regulations
Interpersonal Skills & Attributes
* Innovative, resourceful, and outcome-driven
* Ability to successfully manage multiple competing priorities
* High attention to detail and quality control
* Strong verbal and written communication skills
* Excellent critical thinking skills and proven track record with presenting quantitative information tonon-technical stakeholders
The salary range for this role is $76,000.00 to $85,000.00 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). 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.
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 *************************** 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. We understand that healthcare is local and we are better 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.
$76k-85k yearly 7d ago
Sr. Managed Care Coordinator (Credentialing)
Privia Health 4.5
Remote
The Sr. Managed Care Coordination Specialist plays a vital role in the organization's Credentialing and Provider Enrollment Department. This position is responsible for the timely and accurate preparation and submission of provider rosters to contracted health plans (payers) to ensure that all providers are appropriately paneled and able to bill for services. The role will work closely with the credentialing team, providers, internal stakeholders, care centers, and external health plan contacts to maintain compliance with all managed care contracts and regulatory requirements.
* Lead the preparation and submission of comprehensive provider rosters to Managed Medicare, Medicaid, and commercial payers.
* Data Reconciliation: Audit internal provider data (NPI, licenses, specialties, locations) against database records to ensure 100% accuracy before submission.
* Manage all payer portal uploads and secure email submissions, maintaining a detailed log of submission dates and confirmation IDs.
* Serve as the primary point of contact for health plans to resolve roster discrepancies, rejections, or paneling delays.
* Maintain roster formats in accordance with individual payer requirements and regulatory standards.
* Utilize internal databases to provide weekly status reports and analyze provider enrollment timelines for process improvement.
* Partner with Revenue Cycle Management (RCM) to identify, troubleshoot, and resolve provider load issues causing claim denials or billing gaps.
* Other duties, as assigned.
* 5+ years in healthcare credentialing, provider enrollment, or managed care analysis.
* Advanced Excel proficiency required. Candidates must be able to perform VLOOKUPs, pivot tables, and data cleaning for large datasets.
* Familiarity with credentialing databases for data management, reporting, and tracking. Experience in CredentialStream preferred.
* Deep understanding of CAQH, NPI, Availity and the provider enrollment lifecycle required
* Experience in Salesforce case management system preferred
* CPMSM, CPCS, or CPES certification through NAMSS preferred
The salary range for this role is $60,000.00-$65,000.00 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 15%. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.
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 *************************** 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. We understand that healthcare is local and we are better 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.
$60k-65k yearly 6d ago
Associate HIPAA Privacy & Data Security Director
Privia Health 4.5
Remote
Under the direction of the Chief Privacy Officer and in close collaboration with the Chief Information Security Officer, the Associate Privacy & Data Security Director will assist with maintaining an effective privacy and data security program, including, but not limited to providing consultative services on privacy and patient confidentiality issues, developing and reviewing policies and procedures, and oversee the privacy and data security program.
Primary Job Duties:
* Initiates, facilitates, and promotes activities to foster a culture of privacy and data security compliance within Privia
* Provides guidance and direction on HIPAA Privacy and Security rules and other applicable federal and state health care privacy laws
* Assists in the development, implementation, and maintenance of administrative, physical, and technical safeguards for personally identifiable data, including, but not limited to managing user access, enforcing least-privilege principles, and maintaining system audit logs
* Periodically reviews and proposes revisions to Privia's Privacy and Security Policies and Procedures and guidance materials to facilitate compliance with new privacy or cybersecurity-related laws/regulations or changes to existing federal, state, and local privacy or cybersecurity rules and regulations
* Collaborates with the CPO and CISO on the development of privacy and security training modules
* Assists ongoing privacy and security compliance monitoring and auditing activities, including staff awareness programs on phishing, ransomware, and insider threats
* In collaboration with the CPO and CISO, supports investigations of privacy and security incidents, breach risk assessments, and reporting to affected individuals and, when needed, HHS-OCR or other applicable agencies
* Maintains rapport with all business units to facilitate spirit of collaboration
* Collaborates with Information Security including conducting and reviewing security risk assessments to facilitate the implementation of effective mitigation of identified risks
* Assists with the implementation and management of PCI-DSS standards and SOX controls
* Other duties as assigned
* Demonstrated knowledge in HIPAA Privacy, HIPAA Security, applicable state Privacy statutes and regulations, NIST Cybersecurity framework, 405(d) Health Industry Cybersecurity Practices, PCI, and SOX
* Working knowledge of medical group operation processes
* Ability to detect deficiencies in processes and determine needs to improve outcomes
* 5+ years of general healthcare privacy and security compliance experience with knowledge of medical group operations and physician services
* 5+ years of experience in regulatory research and knowledge of federal, state healthcare privacy and security requirements
* HIPAA Privacy Officer or Security Officer experience preferred
* Certified in Healthcare Privacy Compliance (CHPC) or other relevant certifications strongly preferred.
The salary range for this role is $118,000-$128,000 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 15% and restricted stock units. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.
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 *************************** 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. We understand that healthcare is local and we are better 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.
$118k-128k yearly 19h ago
Operations Development & Integration Associate Director
Privia Health 4.5
Remote
Privia Healthâ„¢ 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
Location: 10% Travel
The National Training Person will be responsible for leading the development, implementation, and execution of onboarding and refresher training and mentoring programs across our national performance operations team - which includes Operations Consultants and Client Success Associates. This critical role will ensure that our workforce is equipped with the necessary skills and knowledge to meet organizational goals, maintain high performance standards, and adapt to evolving industry demands and company growth. The National Training Person will foster a culture of continuous learning and professional development, aligning training program goals and objectives with the strategic business needs of our markets and product lines.
Key Responsibilities
Strategic Training & Capabilities Leadership:
Develop and execute a comprehensive national training and mentorship program aligned with the company's overall business objectives and growth plans.
Conduct comprehensive training needs analyses by collaborating with market leadership, reviewing performance data, and gathering customer feedback to identify skill gaps and strategic development opportunities.
Ensure training programs are innovative, effective, and compliant by continuously researching and integrating best practices, new learning technologies, and regulatory changes.
Program Development and Management:
Design, develop, and implement engaging and effective training programs (e.g., onboarding, technical skills, compliance, customer service).
Design a nimble and responsive training and mentorship program that can quickly adapt to evolving business needs.
Lead the end-to-end development of a range of training materials, from comprehensive e-learning modules and presentations, practical job aids and best-practice guides ensuring all resources are current and accessible.
Ensure program alignment across all systems/processes/workflows that are used by the Operations Consultant and Client Success Associate staff. Similarly, monitor and drive alignment across tools/resources used by care centers.
Ensure cost-effective delivery of a high-quality program.
Evaluate the effectiveness of training programs through participant feedback, performance metrics, and ROI analysis, making continuous improvements as needed.
Stakeholder Collaboration:
Collaborate closely with market operations leaders, HR business partners, and subject matter experts to ensure training programs address specific departmental needs and challenges.
Communicate regularly with market leadership regarding training progress, challenges, and successes.
Ensure consistent delivery and quality across all markets.
Other Responsibilities/Expectations:
Mentor and develop a high-performing team, creating a culture of excellence and continuous professional growth
Identify and manage external vendors and consultants when specialized expertise is required.
Qualifications
Deep care center, MSO experience - 5-7+ years.
Direct experience actively working in a medical practice operations role having successfully navigated common challenges & exceptions.
Possess the depth of understanding nuances and edge cases crucial for real-world complexities.
Proven experience creating and implementing programs, models and workflow solutions to resolve complex care center situations.
Demonstrated ability to have difficult conversations with regard to clinic operations and financial topics.
Experience in designing, developing, and implementing a wide range of training programs.
Understanding of learning principles, program design, and training methodologies.
Skills:
Background that allows ‘training person' to speak from real-world application, not just theory.
Excellent leadership and management skills.
Excellent verbal and written communication skills are essential to explain complex concepts clearly, patiently, and in an engaging manner. Able to tailor their communication style to different learning preferences.
Strong analytical and problem-solving abilities.
Ability to use learning management systems (LMS) and e-learning authoring tools.
Ability to manage multiple projects simultaneously and meet deadlines.
Strategic thinking and business acumen.
Results-oriented with a strong focus on continuous improvement.
Adaptable and flexible in a dynamic environment.
Ability to inspire and motivate others.
The salary range for this role is $115,000.00 to $135,000.00 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs)
. This role is also eligible for an annual bonus targeted at 15% and restricted stock units. 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 *************************** 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. We understand that healthcare is local and we are better 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.
$115k-135k yearly 8d ago
Sr. Practice Operations Analyst
Privia Health 4.5
Remote
We're seeking a Senior Analyst, Practice Operations to join our Analytics team, enabling physician leaders to make data driven decisions on financial, operational, and clinical opportunities. This person will be responsible for developing analyses, reports, models, and presentations for internal stakeholders as well as owners of Privia Medical Group practices.
* Develop benchmark comparisons and financial models to project the economic impact of changes to practice staffing, patient access, productivity, payer mix, clinical quality, workflow, revenue cycle, etc.
* Root cause analysis and opportunity identification to improve practice and market performance
* Work directly with practices and market leaders to help prioritize and evaluate same-store growth opportunities
* Utilize structured analytical thinking to synthesize valuable insights and present findings to physician executives, market presidents, and practice consultants
* Discover, innovate, and implement process improvements to improve analytics team efficiency and scale analytic product solutions
* Contribute to strategic plans to improve physician satisfaction, patient satisfaction, and practice profitability
* Help to manage relations between IT, Product Engineering, and functional business areas for the delivery of technology solutions to stakeholders
* Other duties as assigned
* Bachelor's degree in business, operations, finance, STEM or related field preferred or equivalent experience.
* 4+ years' experience in healthcare consulting, strategy, or analytics with a focus on using data to drive operational change and insight, with a proven track record of driving ROI
* 3+ years of experience using SQL in large relational databases to query and cleanse data, with proven data validation processes
* Experience optimizing the performance of a healthcare organization, preferably in Primary Care practice operations
* Demonstrated proficiency in comprehensive financial statement analysis, including detailed P&L interpretation, Balance Sheet assessment, and the development of Pro-Forma models
* Ability to think critically, applying analytical frameworks to complex business problems to synthesize insights
* Able to remain flexible and responsive in fluid situations with simultaneous projects and to appropriately prioritize
* Ability to establish and maintain collaborative relationships in high-pressure, fast-moving matrixed environments and motivate others to action
* Excellent presentation skills with the ability to tailor the communication style to the audience, including analytics professionals, senior business leaders, physicians, and practice managers
* Experience creating reports through BI tools, such as Tableau, Microstrategy, QlikView, and/or Looker
* Support product development through design, build, and delivery of analytics-centric products
* Must comply with HIPAA rules and regulations
The salary range for this role is $93,600.00 to $104,000.00 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 15% . The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.
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 *************************** 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. We understand that healthcare is local and we are better 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.
$93.6k-104k yearly 22d ago
Manager, Care Advice Line
Privia Health 4.5
Remote
The primary role of the Manager, Care Advice Line will be responsible for managing the team that provides our patients with on-demand telephone-based care management services through a 24/7 Nurse Advice Line (i.e. telephone triage). Care Managers will assess symptoms/concerns of callers to determine the urgency and type of care needed, refer to or schedule appointments with providers as appropriate, and give health information and advice to callers. The goal of the Care Advice Line is to reduce unnecessary visits to the clinic and emergency department, provide information for self-care and symptom management, and to coordinate care across the healthcare delivery system. Care Managers operate in a team-based model, acting as an extension of the primary care provider.
* Day to day oversight and ongoing development of the CAL operations, staffing, metric achievement and QAIP ensuring a 24/7 platform.
* Handles inbound communications from patients who are seeking information about symptoms or care concerns.
* Conduct outbound communications for follow-up and care coordination.
* Consult and coordinate with internal and external team members to assess, plan, implement and evaluate patient care plans, make appropriate referrals, and provide follow-up.
* Assist with finding appropriate providers, community resources, care solutions and coordinate priority appointments.
* Record member data in Privia's web-based medical record system and associated EMRs, or health portals.
* Research and dissimeniate information online and in Privia's internal knowledge databases.
* Provide health information, coaching, and critical thinking skills to assist our members with medical and wellness related issues
* Other related care management activities and projects as appropriate and needed (e.g. PVH support, close "gaps in care," complex care plans, etc.)
* Willing and able to:
* Master necessary tasks of the CAL to work autonomously sharing in the ongoing leadership, training and growth of the program.
* Directly work up to 80% of their workweek on nights, (between 12am-8am); every other weekend and 1/3 of the national holidays on average.
* Provide up to 10 hours/ week or 40 hours/ month, on average of on-call coverage being readily accessible and within 30 minutes of queue during those times.
* Coordinate PTO with other Lead(s) and Associate Director as able.
* Other duties as assigned
* Registered Nurse (RN) with current resident compact licensure. License must be unencumbered and must have the ability to apply for nursing licensure in multiple states.
* Experience in a call center, triage position, consulting environment or like environment.
* Leadership experience.
* 5+ years of recent clinical experience, with problem-solving and critical-thinking skills
* Flexibility to provide overnight, weekend and/or holiday coverage on a rotating basis
* Disease Management, Case Management, Utilization Review or Wellness experience
* Without question, 'Exceptional Customer Service'
* Strong computer skills. Internet savvy
* Clear, confident communication and listening skills
* Self -motivated and self-disciplined a must
* Strong entrepreneurial spirit. A desire to work in a highly rewarding, rapidly growing, environment
* Willingness to do what it takes to get the job done and make patients the number one priority
* Able to thrive in a quiet, secure home office environment
* Detailed-oriented, organized with the ability to work well in fast-paced work environment
* Masters, Advanced Degree and/or Professional Certification preferable
* Case Manager or Wellness Coaching certification preferred
The salary range for this role is $85,000 to $95,000 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 15% & restricted stock units. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.
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 *************************** 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. We understand that healthcare is local and we are better 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.
$85k-95k yearly 22d ago
Provider Recruitment Associate
Privia Health 4.5
Remote
The Provider Recruitment Associate will support the growth of Privia Health by assisting the Provider Recruitment team with the logistics of the recruitment process to result in the successful placement of physician and advanced practitioner candidates within our care center practices
* Develop and maintain working knowledge of our practice model and regional communities in order to assist with candidate inquiries
* Work with physician recruiters to profile new requisitions and develop practice job descriptions
* Work with physician recruiters to identify, source, pre-screen and schedule qualified candidates (APP's and Physicians) for further evaluation for open requisitions
* Manage sourcing activities for all open requisitions and log activities in the applicant tracking system
* Manage outbound communication campaigns, including broadcast emails, mailings, and other mass communications for physician and advanced practitioner requisitions
* Provide support to Provider Recruitment Coordinator and physician recruiters with candidate interview processes, both telephone interview and site visit coordination, which may include arrangements for travel, lodging, etc.
* Assist in the development and ordering of physician recruitment marketing collateral
* Manage off-site recruitment events, such as regional and national conferences
* Develop and maintain provider recruitment resource library
* Continually develop upon processes, policies, and strategies to improve upon operations resulting in recruited providers
* Delegate tasks to provider recruitment interns/contractors as necessary
* Establish high reach objectives, personally track and report on performance
* Other duties as assigned
* Bachelor's Degree and at least one year related experience preferred
* Previous healthcare sales or recruiting experience preferred
* Strong computer technology skills including, but not limited to, Microsoft Outlook, Microsoft Word, Excel, PowerPoint, SalesForce and social media outlets
* Superior marketing and public relations skills with the ability to communicate clearly and professionally to present practice opportunities in a positive manner
* Proven track record of exceptional customer service skills
* Demonstrated ability to conduct Internet research in an efficient, productive manner
* Must comply with HIPAA rules and regulations
* Excellent communication skills with the ability to engage at all levels of the organization. Demonstrate a professional and adaptable demeanor with internal and external clients, including administrators, physicians, peers, and support staff.
* Exhibit a high energy level, and demonstrate the ability to work as a team, with flexibility in work habits to schedule and meet the needs of the medical staff.
* Proven ability to multi-task, planning and prioritizing a large volume of detail-oriented work in accordance with changing deadlines.
The hourly range for this role is $20.00-$26.45 per hour and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for a commission based incentive plan between $10,000.00-$13,000.00. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.
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 *************************** 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. We understand that healthcare is local and we are better 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.
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 *************************** 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. We understand that healthcare is local and we are better 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.
$20-26.5 hourly 22d ago
Associate Director, Payer Enrollment
Privia Health 4.5
Remote
Privia Healthâ„¢ 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 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.
Job Responsibilties:
Ensure protocols are being followed to ensure timely resolution and completion of payor enrollment to ensure no loss of revenue due to untimely payor enrollment
Assures compliance with all health plan requirements as related to the provider certification and credentialing.
Reviews and streamlines processes and workflows for the on-boarding department, using automation, where appropriate
Works with both internal and external stakeholders to provide regular updates and resolve complex provider enrollment status and/ or issues, including resolving claim denials related to provider enrollment
Works with technical staff to develop tools and procedures for auditing and reporting with the goal of streamlining credentialing processes and communicating with company and external stakeholders
Oversees special projects requiring knowledge of delegated and non-delegated health plan requirements
Interacts with varied levels of management, physician office staff and physicians effectively to accomplish credentialing and various elements of implementation and launch
Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.
Maintains 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 the payers, contracted MSO facilities and PMG
Coordinate and prepare reports
Record and track credentialing statistics
Other duties as assigned.
Qualifications
7+ years' experience in managed care credentialing, billing and/or Medical Staff service setting
Experience leading Enrollment teams with large provider inventory
Demonstrated skills in problem solving, analysis and resolution
Intermediate/advanced Microsoft Excel skills required
Experience using Verity CredentialStream preferred
Athena EMR experience preferred
Experience supporting Medicare/Medicaid required
Strong knowledge of NCQA guidelines & delegated payers preferred
Must be able to function independently, possess demonstrated flexibility in multiple project management
Must comply with HIPAA rules and regulations
The salary range for this role is $95,000.00-$100,000.00 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 15% and restricted stock units. 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 *************************** 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. We understand that healthcare is local and we are better 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.
$95k-100k yearly 3d ago
Payer Contracting Analyst
Privia Health 4.5
Remote
Privia Healthâ„¢ 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 Payer Contracting Analyst is a key contributor on our Payer Contracting team in enabling both the
team and other departments to make better data driven decisions on financial, operational, and clinical
initiatives. This position will play a key supporting role in the development, analysis, and optimization of
commercial and government payer contracts within the organization. This role covers internal and external
customers and requires working cross-functionally to understand evolving business needs and
requirements. This Privia Partner will be responsible for helping to design and develop reports,
presentations, and models to guide strategic decision making of our stakeholders. The Analyst works to
deliver data-driven insights to key stakeholders across the enterprise. The Analyst assists in the
development of end-to-end analytics solutions efforts, working with cross-functional teams to deliver on
evolving requirements and business needs, build scalable reports and applications, and deliver solutions
that ultimately empower end-users in making data-driven business decisions. The Analyst also supports the
execution of business- and client-facing ad hoc analyses, using data to guide strategic discussions among
and between internal and external stakeholders.
Conduct quantitative analyses to evaluate payer performance, utilization trends, cost drivers, and reimbursement outcomes.
Develop insights that support contract strategies, rate negotiations, and value-based care program underwriting.
Responsible for assessing legal and financial implications of all contracting opportunities, including new contacts, contractual amendments and assignments to existing contracts.
Build and maintain fee schedule models to forecast expected reimbursement under various contract terms.
Perform scenario analysis and assess financial impacts of proposed rate changes, proposals, or contract structures.
Assist in the development of value-based care financial models, including shared savings, bundled payments, quality incentive programs, and care coordination fees.
Support ongoing monitoring of value-based program performance and emerging opportunities.
Write SQL queries to extract and analyze medical claims data.
Develop standardized reports and dashboards used for internal reviews and external payer discussions.
Ensure data accuracy, completeness, and consistency across analytical deliverables.
Work closely with the Payer Contracting team to translate analytical findings into compelling
insights that inform negotiation strategy.
Collaborate with our Revenue Optimization and Payer Contracting teams to develop reports and alerts that will ensure that Privia is being paid appropriately for fee-for-service andpay-for-performance contracts.
Partner with Finance, Population Health, Revenue Cycle, and Clinical Operations teams as needed.
Qualifications
Bachelor's degree in a quantitative field (e.g., Economics, Finance, Statistics, Mathematics, Computer Science) or equivalent professional experience; healthcare environment experience preferred.
Experience using SQL
Strong Microsoft Excel skills, including pivot tables and advanced formulas
1+ years experience working with healthcare claims data preferred
Strong project management and analytical skills, including a desire to logically solve business andtechnology problems
Must comply with HIPAA rules and regulations
Interpersonal Skills & Attributes
Innovative, resourceful, and outcome-driven
Ability to successfully manage multiple competing priorities
High attention to detail and quality control
Strong verbal and written communication skills
Excellent critical thinking skills and proven track record with presenting quantitative information tonon-technical stakeholders
The salary range for this role is $76,000.00 to $85,000.00 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs)
. 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 *************************** 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. We understand that healthcare is local and we are better 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.