RCM Systems & Enrollment Analyst

Privia Health™ is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.

RCM Systems & Enrollment Analyst is a critical role responsible for identifying, analyzing, and resolving conflicts and inconsistencies across revenue cycle management (RCM) and provider credentialing and enrollment processes. This individual will focus on preventing revenue leakage by ensuring data integrity across all systems, validating system configurations, and driving cross-departmental process improvements.

Primary Job Duties:

• Under the direction of the Senior Manager, Athena Systems, completes all EFT, ERA, EDI set up and enrollment with all health plans through claims system or payor portal.

• Conducts regular follow up with all health plans to obtain statuses of provider submissions.

• Works with other Privia partners is addressing any provider enrollment issues.

• Identify and resolve revenue leakage through RCM data analysis.

• Ensure accuracy and consistency of provider and practice data across EHR, credentialing, and payer systems.

• Maintain and validate enrollment tables, matrices, and system configurations.

• Review and optimize EHR rules to prevent credentialing and billing-related claim denials.

• Collaborate cross-functionally to resolve data and workflow issues.

• Develop reports and dashboards to track KPIs and revenue impact.

• Document and share processes, system rules, and best practices.

• Supports special projects requiring knowledge of delegated and non-delegated health plan requirements

• Coordinate and prepare reports

• Record and track credentialing statistics

• Bachelor's degree in Healthcare Administration, Finance, Business, or a related field preferred, or equivalent work experience

• At least 3 years experience in managed care credentialing, billing and/or Medical Staff service setting

• Demonstrated skills in problem solving and analysis and resolution

• Advanced Microsoft Excel skills

• Must be able to function independently, possess demonstrated flexibility in multiple project management

• Must comply with HIPAA rules and regulations

• Prefer knowledge of EFT, ERA, EDI enrollment and claims systems.

• Must have Athena system knowledge.

• Knowledge of Athena payer enrollment table strongly desired

The salary range for this role is $54,000,00 to $57,000,00 in base pay and exclusive of any bonus 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 https://www.speedtest.net/. This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.

Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. 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.