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.

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 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.