Provider Enrollment Specialist

We are recruiting for a motivated Provider Enrollment Specialist to join our team!

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Department

Medical Staff Services and Provider Enrollment

Job Summary
Under minimal supervision coordinates, monitors and maintains Medicare, Medicaid and Dental Plans enrollments for the Medical Staff, Advanced Practice Providers and Billable Non-Privileged Providers. Ensures compliance with the accrediting and regulatory agencies (i.e., TJC, NCQA, and CMS) in regard to credentialing and government enrollments while developing and maintaining a working knowledge of the statues and laws.
Essential Functions:

• Coordinates and facilitates the enrollment of professional providers with various payers for professional services and governmental reimbursement through, Medicare and Medicaid. (45%)
• Reviews provider credentialing and/or recredentialling/revalidation data for accuracy based on licensing requirements and various insurer and government payer requirements. Obtains information from professional providers and other resources. (10%)
• Completes timely application processes based on payer and government specific formats. Continually follows up on enrollment and/or recredentialling/revalidations statuses until complete. Resolves issues as they are identified in a timely manner. (5%)
• Maintains systems/applications used in the enrollment processes. (5%)
• Completes provider payer enrollment/credentialling and recredentialing with all identified payers in a timely manner. Handles highly sensitive and confidential information regarding professional providers. (5%)
• 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. (5%)
• 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. (5%)
• 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. (5%)
• 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. (5%)
• 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. (5%)
• Develops databases and spreadsheets for tracking organization providers. Ensures data is accessible/transparent for executive inquiries or other information as deemed necessary by management. (5%)

Education:

• High School Diploma or GED Required

Work Experience:

• 1-3 years Minimum three years experience in credentialing and enrollments with Payors, Medicare, Medicaid and Dental Payors. Required

Licenses:

Knowledge, Skills and Abilities:

• 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
• Must be able to work independently and meet schedules and deadlines
• Ability to consistently implement program, department and organizational policies and procedures.
• MD Staff knowledge is preferred

Shift

Days (United States of America)

Work Type

Regular

Salary

$23.15 - $31.32 / hr

Benefits

• Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans

• Free RTD EcoPass (public transportation)

• On-site employee fitness center and wellness classes

• Childcare discount programs & exclusive perks on large brands, travel, and more

• Tuition reimbursement & assistance

• Education & development opportunities including career pathways and coaching

• 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

Our Values

• Respect

• Belonging

• Accountability

• Transparency

All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.
Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver’s 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.
As Colorado’s primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.
Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.
We strongly support diversity in the workforce and Denver Health is an equal opportunity employer (EOE).

Denver Health values the unique ideas, talents and contributions reflective of the needs of our community. For more about our commitment to diversity visit: https://www.denverhealth.org/for-professionals/careers/diversity-and-inclusion

Applicants will be considered until the position is filled.