Provider Enrollment Specialist

🔥 1 minute ago

⛰️ Colorado – Remote

⛰️ Colorado – Remote

💵 $24 - $34 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Denver Health

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1860

⚕️ Healthcare Insurance

🤝 Non-profit

📡 Telecommunications

Healthcare Insurance • Non-profit • Telecommunications

Denver Health is a comprehensive and integrated health system providing compassionate, mission-based healthcare services to the Denver community and the state of Colorado. With a rich history spanning over 164 years, Denver Health operates numerous facilities including a main campus, family health centers, urgent care clinics, and a school-based health center. The organization is dedicated to delivering exceptional care through its team of over 8,200 employees, and offers services such as telehealth, myChart patient portal, pharmacy assistance, and various specialized healthcare services including orthopedics, bariatric surgery, and emergency services. Denver Health also plays a significant role in public health and community welfare, serving approximately one-third of all births in Denver and supporting numerous public school health programs. As a non-profit health system, Denver Health emphasizes accessibility and community engagement, evidenced by numerous awards and funding initiatives to support its mission.

📋 Description

• Under minimal supervision coordinates, monitors and maintains Medicare, Medicaid and Dental Plans enrollments for the Medical Staff and Advanced Practice Providers • Ensures compliance with the accrediting and regulatory agencies (i.e., TJC, NCQA, and CMS) in regards to credentialing while developing and maintaining a working knowledge of the statues and laws • Coordinates and facilitates the enrollment of professional providers with various payers for professional services and governmental reimbursement through Medicare and Medicaid • Reviews provider credentialing and/or recredentialling/revalidation data for accuracy based on licensing requirements and various insurer and government payer requirements • Completes timely application processes based on payer and government specific formats • Continually follows up on enrollment and/or recredentialling/revalidations statuses until complete • Maintains systems/applications used in the enrollment processes • Completes provider payer enrollment/credentialling and recredentialing with all identified payers in a timely manner • Handles highly sensitive and confidential information regarding professional providers • Resolves enrollment issues through collaboration with physicians, non-physicians, office staff, management, contracting, insurers, and others as identified • Maintains positive working relationships with providers • Plays an active role in explaining and informing providers and practice/office managers of the submission requirements for credentialing/recredentialing processes, stressing the importance of compliance with these processes • Obtains updated provider information from various sources including provider offices, state licensing boards, malpractice insurance companies, residency training programs, etc • Identified and resolved problems with primary source verification elements by interpreting, analyzing, and researching data • Proactively obtains updated provider credentialing data prior to expiration • Creates, develops, and maintains applicable matrices and/or utilizes departmental software that supports the enrollment functions • Completes all additions, updates, and deletions • Supports new provider onboarding processes related to enrollment • Provides updates to on-site practice management staff and others with any changes to requirements for credentialing individual providers based on government and commercial payer credentialing processes • Proactively communicated any changes regarding contracting as it relates to enrollment and operations • Communicates updated payer enrollment information including payer provider numbers to practice operations in a timely manner while fostering working relationships and teamwork with departments, vendors, etc. • Develops databases and spreadsheets for tracking organization providers • Ensures data is accessible/transparent for executive inquiries or other information as deemed necessary by management

🎯 Requirements

• High School Diploma or GED • Required or PESC Certification • 4-6 years Of experience in credentialing and enrollments with Payors, Medicare, Medicaid and Dental Payors Required or less than 1 year PESC Certification • Knowledge of federal and Colorado statutes, legislative initiatives and regulations, as well as federal, State and local policies • Knowledge of TJC, NCQA and/or CMS credentialing standards • Proficient in Microsoft Word, Excel, and Outlook • Ability to simultaneously coordinate and manage several functions, programs, and tasks in various stages of completion • Ability to interpret and apply policies and procedures • Skilled in providing excellent customer service • Ability to communicate in a professional and positive manner • Ability to consistently implement program, department and organizational policies and procedures • Must be able to work independently and meet schedules and deadlines. MD Staff provider enrollment knowledge is preferred

🏖️ Benefits

• Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays • 100% paid parental leave up to 6 weeks • Immediate eligibility for retirement plans with employer contribution up to 9.5% • Generous medical, dental, vision plans in addition to employer paid disability and life insurance • Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center • Free RTD EcoPass (public transportation) • Childcare discount programs & exclusive perks on large brands, travel, and more • Tuition reimbursement & assistance • Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways • Professional clinical advancement program & shared governance • Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program • National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer