Job Description

The senior Medicare Program Analyst will work cross-functionally within the team, helping develop a purpose-driven analytics platform to maximize our analytics capabilities and performance. This role's primary emphasis is building, automating, and optimizing technical processes for running Medicare Value-Based Care Program MVBCP) analytics.

Primary Job Duties:

• Develop proprietary solutions to provide the business with the best analytics to drive success in existing and new contracts
• Develop integration and automation of MVBC analytics processes to achieve superior service in providing insights to internal and external stakeholders
• Enable the MVBC team to achieve higher efficiency in performing analyses and running reports by:
  • Improving the performance and scalability of databases, SQL scripts, and SAS programs
  • Designing, building, and running ETL programs and automation scripts for extracting, cleaning, transforming, and loading claims, EMR, clinical, and third-party data using SAS (9.4) and SQL (Snowflake)
  • Collaborating with the team members to design ETL & automation workflows
  • Ensuring data integrity, data accuracy, and completeness by developing Quality Assurance (QA) checks
  • Evaluating and improving existing QA checks
  • Documenting technical processes for future reference
  • Providing expertise to team members in technical aspects of building healthcare analytical solutions
• Assume leadership in representing the MVBC team in organization-wide infrastructure-related projects such as database, platform, and application migration
• Collaborate closely with IT leadership, engineers, and 3rd parties to build and enhance business analytics to support Privia Health’s VBC business
• Learn and understand the Medicare regulatory landscape related to healthcare data, analytics, Shared Savings programs, and Accountable Care Organizations (ACO)

Qualifications

• Proven record in building automation, ETL, and scalable analytics using SAS and SQL
• Strong experience with SAS and SQL required
• Bachelor’s Degree preferred in healthcare or a quantitative major (e.g., public health, engineering, analytics, economics, actuarial sciences, statistics, healthcare information systems) OR relevant equivalent experience preferred 
• Experience working at a health plan, hospital system, ACO, provider organization, consulting firm, technology start-up, or previous analytics experience and capabilities preferred
• Experience with Snowflake environment preferred

Interpersonal Skills & Attributes:

• Communicates complex information and concepts. Creates clarity and adjusts style to the expertise of the audience
• First thing first, prioritizes based on the needs of the MVBC team and business
• Outcomes-driven, delivers with impeccable planning and time management
• Performance-driven, keeps the team’s goals at the forefront and prioritizes daily         activities to meet those goals
• Comfortable in a rapidly evolving environment
• Highly collaborative and effective across an organization and amongst multiple stakeholders
• Must comply with HIPAA rules and regulations

The salary range for this role is $82,500.00 to $110,000.00 in base pay and exclusive of any bonuses or benefits. This role is also eligible for an annual bonus targeted at 15% and restricted stock units based on performance in the role. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

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Job Description

Reporting to the Director, Credentialing & Enrollment, the Manager, Credentialing is responsible for all aspects of the credentialing, re-credentialing and privileging processes for all providers in Privia’s high performance medical group. 

Essential Functions:

• Assures compliance with all health plan requirements as related to the provider certification and credentialing. Manages and monitors activities of the department to ensure compliance with all policies/procedures and regulations
• Reviews and streamlines processes and workflows for the onboarding department, using automation, where appropriate
• 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
• Ensures that NCQA standards are being followed in policies and procedures
• Assigns associate’s files and ensures they are completed timely per KPIs/Metrics
• Reviews monthly KPIs with associates to ensure they are meeting/exceeding goals by the 15th of each month
• Manages day-to-day activity of Credentialing Specialists
• Responsible for career development and growth of entry-level employees on team
• Works closely with market implementation leaders to ensure smooth Go Lives for new groups
• 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. In addition, the Manager is responsible for all audits to ensure that delegated credentialing entities are compliant
• Coordinate and prepare reports
• Ensures data integrity for all providers
• Assists in oversight and completion of all delegated audits
• Assists with the data validation process for rosters
• Record and track credentialing statistics
• Perform other duties as assigned

Qualifications

• 5+ years’ experience in managed care credentialing, billing and/or Medical Staff service setting required
• Knowledge of NCQA standards
• People management 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:

• Eager to embrace the challenges and opportunities to build a Credentialing department with in a rapidly growing start-up environment.
• An individual with the ability to communicate appropriately and effectively with practitioners and 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 in interpreting NCQA, Joint Commission, URAC, CMS and State Laws and regulations as they pertain to the credentials of PMG Providers
• Ability to problem solve and explore all options and to use available resources to find new and effective solutions
• Prioritize and meet deadlines on an ongoing basis to ensure timely completion according to process requirements

The salary range for this role is $70,000.00-$75,000.00 in base pay and exclusive of any bonuses or benefits. This role is also eligible for an annual bonus targeted at 15% andrestricted stock units. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

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Job Description

The Program Manager, Value Based Care acts as a strategy and operational leader for the Value Based Care (VBC) team in the Florida market and across the company. The Program Manager is responsible for creating strategy and processes within their specific market in Privia Health to succeed in VBC outcomes, such as identifying and establishing tactics with providers and network partners and working with internal teams to implement new technologies and solutions. This position will coordinate strategy and operations for Medicare (MSSP), Medicare Advantage, Medicaid, and Commercial VBC programs for a team of Quality and Population Health associates.

• Become a subject matter expert and build strategy on key opportunity areas by understanding the details of Privia’s VBC payer contracts and the outcomes they require
• Design workflows to meet contract measures and partner with staff to implement them, including building process documentation for total cost of care, risk adjustment and quality measures
• Work closely with physician leaders to review population health training, initiatives, and data, along with co-leading provider committees as needed
• Collaborate with external payer team members on strategies for VBC contracts
• Manage and support relationships between internal partners and facilitate best practice sharing
• Work with teams across the company to support their key processes or areas of improvement
• Manage day to day operations of direct employees to include, hiring, training, development and performance management.
• Working knowledge of EHR quality management programs
• Perform other duties as assigned

Qualifications

• Bachelor’s degree in Healthcare Administration, Public Health, Nursing, or similar field required; Master’s degree preferred
• 5+ years of experience working in health plans, health systems, or provider organizations, managing value-based and risk-based contracts required
• Analytical, quantitative, and metrics driven; must know how to interpret value-based program requirements and understand the impact on financial results
• Strong project manager able to juggle multiple projects and urgent deliverables across a wide variety of teams and stakeholders
• Must reside in market of assignment
• Must comply with HIPAA rules and regulations

The salary range for this role is $92,000  to $115,000 in base pay. 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.

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Job Description

The Systems Optimization Manager will be responsible for optimizing and assisting with ongoing management of operational processes that span across our technology platform, especially Salesforce, aligning them with Privia Health’s mission to optimize healthcare delivery through an integrated and efficient approach. The Systems Manager leads requirements gathering, synthesizes business needs into actionable user stories, and collaborates with leadership across departments to enforce process governance. This role requires a blend of technical expertise, leadership skills, and strong cross-functional communication abilities to successfully manage complex processes and drive organizational improvement initiatives.

• Serve as the central point of contact for managing and overseeing cross-functional processes across our technology platforms, especially Salesforce, ensuring these align with the standards and goals of the company.
• Develop and implement governance structures that ensure clear accountability for operational processes across all teams within Privia Health.
• Facilitate regular governance meetings to drive decisions, build consensus, and prioritize key initiatives across teams involved in supporting our Care Centers. Set governance standards that dictate the way we use and interact with our CRM platform.
• Lead discovery and requirements refinement sessions to uncover customers’ business, functional, and technological needs.
• Synthesize requirements into user stories and partner with the Product team for solution design and build
• Perform fit-gap analysis between our various operational tools and client requirements
• Work with leadership across Privia’s various functions (including Practice Operations, Revenue Cycle Management, and Clinical Operations) to develop a unified strategy for process governance and improvement.
• Act as a liaison across all departments to ensure that governance initiatives and process improvements are effectively communicated, implemented and adhered to.
• Support teams in implementing new processes and monitoring their effectiveness to ensure continuous alignment with Privia’s goals. Develop reporting to track these success measures.
• Establish performance metrics and service level agreements that hold teams accountable to the highest level of operational excellence
• Perform other duties as assigned

Qualifications

• Bachelor’s degree in Business, Healthcare Administration, or a related field preferred or relevant equivalent experience.
• 3+ years of experience in business analysis or process improvement, preferably in a healthcare setting or with experience in healthcare governance.
• Strong understanding and experience with Salesforce
• Familiarity with healthcare operations, especially around practice management, care delivery, and revenue cycle management.
• Strong background in conducting gap analysis, process optimization, and implementing governance structures.
• Proven ability to work collaboratively across clinical, operational, and administrative teams to achieve business goals. 
• Excellent analytical and problem-solving skills, with the ability to turn business requirements into actionable solutions.
• Strong communication skills with experience presenting to leadership and stakeholders at various levels.
• Familiarity with project management methodologies, such as Agile, is a plus.

The salary range for this role is $105,000 to $125,000 in base pay and exclusive of any bonuses or benefits. 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.

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Job Description

The Senior Platform Specialist  is responsible for supporting the athenaOne applications for use by Privia Medical Group clinicians. The Senior Platform Specialist  will work closely with end-users and the Privia Clinical IT team to understand functional business requirements, configure and customize athenaOne content to support these needs and be the subject matter expert in athenaOne functionality. The primary responsibilities of this role will be to manage and resolve complex issues, lead initiatives, and ensure the success of a variety of complex projects. 

Primary Job Duties:

Issues Management

• Act as a Clinical Informatics subject matter expert in assisting users to improve efficiencies with the technologies supporting athenaNet

• Document, track, and take appropriate actions to close or escalate athenaNet related issues in a timely manner

• Assist with testing and troubleshooting all aspects of athenaNet

• Complex issue management and highest-tier issue support

• Provide remote support to assist with EHR issues when needed

• Manage CRM queue to follow SLA parameters

Project Management

• Owns Medium/Large Projects

• Lead project planning sessions

• Manage project progress

• Manage relationship w/ clients & stakeholders

• Support data collection related to system configuration

• Identify opportunities to coordinate with PMO 

Platform Management

• Maintain up-to-date knowledge of the athenaNet software applications

• Maintain and update platform standards across all markets

• Support testing of athenaNet configuration

• Configure and customize athenaOne 

Team Management

• Train employees, end-users, and new providers on athena functionality to ensure proper utilization of the EHR

• Assist with ongoing maintenance of internal process documentation

• Provide oversight and guidance for platform associates and contractor teams

Other

• Maintains confidentiality and complies with Health Insurance Portability and Accountability Act (HIPAA)

• Perform other duties as assigned

Qualifications

• Bachelor’s degree in related field, or equivalent work experience

• Two or more years of clinical and/or managed care experience

• A minimum of two years experience with EHR configuration and customization, athenaNet preferred

• Understanding of clinical terminology

• Experience working in an ambulatory healthcare setting

• Knowledge of ambulatory healthcare operations including referrals, scheduling, registration, check-in, insurance and patient billing operations, patient encounters,

• Experience using Google Suite, including Docs, Sheets,  Slides, Forms, and Sites or equivalent software

• Solid understanding of healthcare informatics

• Analysis, synthesis, and problem solving skills

• Familiarity with CRM systems and practices

• Familiarity with Project Management systems/tools

• Project management experience 

• Experience communicating with stakeholders at all levels of the organization

The salary range for this role is $72,000  to $85,000 in base pay. 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.

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Job Description

The Credentialing Auditor Manager’s responsibility will be to conduct daily audits of 100% of credentialing files to ensure compliance with NCQA standards as well as to ensure that all demographic information is present and correct in the group record.

Primary Job Duties:

• Conducts daily audits of the credentialing files.

• Assists with the development of corrective action steps needed when any trends are identified that need to be addressed.

• Tracks and trends errors in the system and provides monthly reports to leadership with results.

• Attends regularly scheduled meetings with leaders to share results and concerns based on audits.

• Assists with reviews of monthly rosters for any data errors/issues and shares those results with the leadership team for action.

• Makes recommendations for controls and process improvements to the leadership team.

• Follows guidelines in alignment with all health plan requirements as related to the provider certification and credentialing. 

• Follows all CMS guidelines with regard to both individual and group enrollment, identifying areas of opportunity and sharing them with the leadership team.

• Interacts with varied levels of management, physician office staff, and physicians effectively to accomplish credentialing and elements of implementation and launch.

• Plans audits by understanding organization objectives, structure, policies, processes, internal controls, and external regulations. Identifies risk areas that support the policy scope and creates audit measures accordingly.

• Continuously assesses the Credentialing and Enrollment compliance with company guidelines and external regulations and makes effective recommendations for process improvements.

• Identifies gaps in current processes/procedures, completes an analysis, and provides recommendations for policy/procedure revisions and process improvements.

• Due to the sensitive nature of quality audits, ensures that audit records and information are maintained in confidence within the Department and communicated only to affected Leadership.

• Coordinate and prepare reports for the leadership team.

• Record and track credentialing statistics.

• Other duties as assigned.

Qualifications

• 5+ years experience in credentialing and in depth knowledge of NCQA and URAC standards.

• Knowledge and experience using Verity CredentialStream software is a plus

• 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.

The salary range for this role is $65,000.00-$75,000.00 in base pay and exclusive of any bonuses or benefits. 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.

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Job Description

TheGrowth Strategy & Analytics Analystis responsible for overseeing all financial modeling and valuation initiatives for our Privia Medical Group (PMG) clients nationwide. As a member of the Growth Strategy organization, the ROI Analyst provides financial analysis support that enables Privia stakeholders and prospective practices to make business decisions that drive overall business results and facilitate growth of the company.

Primary Job Duties:

• Prepare ROI models for prospective practices interested in joining PMG
• Collaborate with in market sales team to coordinate collection of data, preparation of models and presentation materials
• Assist in developing and refining models to meet changing understanding of our markets and the broader healthcare industry.
• Perform ad-hoc pro-forma financial analyses to help departments throughout Privia and potential customers answer data related questions with limited oversight.
• Foster relationships and cross-functional support between the finance, sales, analytics, and payer teams.
• Strategic thinker who assesses situations carefully and delivers scalable recommendations and results.
• Perform other duties as assigned

Qualifications

• Bachelor’s Degree in Finance, Accounting, Economics or Business degree and Master’s degree preferred
• 1+ years of work experience; Healthcare experience in audit, consulting or a healthcare quantitative field is strongly preferred
• Excel experience required
• Technically savvy; Able to pull reports from several different practice management systems
• Must comply with HIPAA rules and regulations

Interpersonal Skills & Attributes:

• Able to be client facing and think critically about the data that is obtained from clients and prospective clients.
• Ability to work in rapidly growing environment, with excellent attention to detail, multitasking and organizational skills
• Strong communication skills
• Ability to handle high levels of pressure and apply critical decision making with constantly shifting priorities

The salary range for this role is $65,000-$75,000 in base pay and exclusive of any bonuses or benefits. 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.

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Job Description

The Coder+ Quality Assurance Specialist will be accountable for executing the quality assurance program related to CODER+ services provided by Privia Health. The QA Specialist will serve as an integral member of the CODER+ program team, responsible for partnering with vendor partners and internal coders to ensure high quality coding is being performed and that proper feedback is being given. This position will spend the majority of the time reviewing coders, educating coders, and working on various projects that involve coding and education. The ideal candidate will draw on existing expertise in primary care and specialty medical coding, billing and compliance with government and commercial payers and act as a coding resource within the team. The Quality Assurance Specialist will perform Evaluation and Management coding, procedure, ICD-10 and HCPC quality reviews as well as other projects related to physician coding. The ideal candidate demonstrates a thorough understanding of complex coding and reimbursement as they relate to physician practices and clinic settings.

Job Requirements:

• Apply appropriate coding classification standards and guidelines to medical record documentation for accurate coding
• Perform quality assessments of records, including verification of medical record documentation (electronic and handwritten)
• Perform quality assessments of coders completed work to validate standards are met
• Research and answer coding and coding workflow related questions for providers and clinic staff
• Meet with providers and clinic staff as needed
• Educate coders and other staff on appropriate coding guidelines
• Assist in development and ongoing maintenance of processes and procedures for each assigned client
• Collaborate with internal Privia+ and Privia teams
• Collaborate with vendor partners
• Follow coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies
• Assist in the Privia+ day-to-day coding/educational needs as needed
• Other duties as assigned

Qualifications

• 5+ years of provider medical coding experience across medical and surgical specialties
• 3+ years experience in coding audit or quality review work
• AAPC Certified Professional Coder (CPC) certification required
• CPMA preferred 
• Athena EMR experience preferred 
• Experience working in a physician practice setting strongly preferred
• Ability to work effectively with physicians, advanced practice providers (APP), practice staff, health plan/other external parties and Privia multidisciplinary team
• Extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes.
• Must comply with HIPAA rules and regulations
• Passion for efficiency and a drive to reduce redundancy
• Professional, clear, and concise oral and written communication
• Knack for prioritizing efficiently and multi-tasking
• Self-directed with the ability to take initiative
• Competent in maintaining confidential information
• Strong team player with ability to manage up members of team to encourage partnership and cooperation with clinic staff

The salary range for this role is $65,000.00 to $75,000.00 in base pay. This role is also eligible for an annual bonus targeted at 10% based on the performance for the role. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

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Job Description

Reporting to the Director, Credentialing & Enrollment, the Manager, Credentialing is responsible for all aspects of the credentialing, re-credentialing and privileging processes for all providers in Privia’s high performance medical group. 

Essential Functions:

• Assures compliance with all health plan requirements as related to the provider certification and credentialing. Manages and monitors activities of the department to ensure compliance with all policies/procedures and regulations
• Reviews and streamlines processes and workflows for the onboarding department, using automation, where appropriate
• 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
• Ensures that NCQA standards are being followed in policies and procedures
• Assigns associate’s files and ensures they are completed timely per KPIs/Metrics
• Reviews monthly KPIs with associates to ensure they are meeting/exceeding goals by the 15th of each month
• Manages day-to-day activity of Credentialing Specialists
• Responsible for career development and growth of entry-level employees on team
• Works closely with market implementation leaders to ensure smooth Go Lives for new groups
• 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. In addition, the Manager is responsible for all audits to ensure that delegated credentialing entities are compliant
• Coordinate and prepare reports
• Ensures data integrity for all providers
• Assists in oversight and completion of all delegated audits
• Assists with the data validation process for rosters
• Record and track credentialing statistics
• Perform other duties as assigned

Qualifications

• 5+ years’ experience in managed care credentialing, billing and/or Medical Staff service setting required
• Knowledge of NCQA standards
• People management 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:

• Eager to embrace the challenges and opportunities to build a Credentialing department with in a rapidly growing start-up environment.
• An individual with the ability to communicate appropriately and effectively with practitioners and 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 in interpreting NCQA, Joint Commission, URAC, CMS and State Laws and regulations as they pertain to the credentials of PMG Providers
• Ability to problem solve and explore all options and to use available resources to find new and effective solutions
• Prioritize and meet deadlines on an ongoing basis to ensure timely completion according to process requirements

The salary range for this role is $70,000.00-$75,000.00 in base pay and exclusive of any bonuses or benefits. 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.

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