Enrollment Specialist
Enrollment Specialist
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Job Description
We are here for lifes journey.
Where is your life journey taking you
Being the heartbeat of Denver means our heart reflects something bigger than ourselves something that connects us all:
Humanity in action Triumph in hardship Transformation in health.
Department
Medical Staff Services and Provider EnrollmentJob SummaryUnder 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
RegularSalary
$22.19 - $31.07 / hrBenefits
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 Denvers 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 Colorados 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 185000 individuals and 67000 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.
Denver Health is an equal opportunity employer (EOE). We value the unique ideas talents and contributions reflective of the needs of our community.
Applicants will be considered until the position is filled.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
