Provider Enrollment Specialist I

Denver Health•Denver, CO

2d•$24 - $34•Onsite

About The Position

We are recruiting for a mission-driven Provider Enrollment Specialist I to join our team! We're with you for life’s journey. At Denver Health, purpose isn’t just something we believe in—it’s something we live every day, for life’s journey. Our Values Respect | Belonging | Accountability | Transparency 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 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.

Requirements

High School Diploma or GED High School Diploma or equivalent required Required or PESC Certification Required
4-6 years Of experience in credentialing and enrollments with Payors, Medicare, Medicaid and Dental Payors Required
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

Nice To Haves

MD Staff provider enrollment knowledge is preferred

Responsibilities

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. Obtains information from professional providers and other resources.
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 team work 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.

Benefits

Generous paid time off, fully paid parental leave, exceptional retirement contributions, comprehensive health coverage, and nationally recognized well-being programs.
Tuition assistance, career advancement pathways, and professional development
Meaningful financial advantages through loan forgiveness eligibility and employer contributions.
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
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