Centura Health connects individuals, families and neighborhoods across Colorado and western Kansas with more than 21,000 of the most talented hearts and minds in medicine.
Through Centura Health’s 17 hospitals, two senior living communities, health neighborhoods, physician clinics, Flight for Life® Colorado, home care and hospice services, we offer a diverse range of work settings in a Colorado or Kansas community you will love to call home.
Enjoy amazing people, competitive pay, some of the best benefits in the industry and plenty of opportunity for professional growth and development.
If you’re ready to discover the difference of working for a fully-integrated health system with a non-profit, faith-based mission to care, we look forward to receiving your application.
Job Description/Job Posting ID: 107152
Recruiter Contact: Hailey Meseraull
Schedule: Full Time, Days
Responsible for administrative work in directing and coordinating a comprehensive specialized credentialing program to assure compliance with the payer credentialing requirements and delegated carrier agreements and NCQA requirements that are built into our policies and procedures. Work includes responsibility for the coordination of all operational aspects related to delegated credentialing, non-delegated and governmental credentialing, including organizing and assisting programs required for establishing procedures for payer credentialing of physicians / allied health professionals. Complete all required governmental forms for Medicare and Medicaid timely and follow through till completion and assigned numbers and effective dates. Complete tracking tool for credentialing processes and effective dates. Assist with completion and updates of Council for Affordable Quality Healthcare (CAQH) profiles. Up to 25% travel to CHPG practices to gather required credentialing information to support the NCQA, CMS and URAC requirements. Build relationships with commercial and governmental carriers to follow-up on outstanding items, through obtaining assigned effective dates or confirmation of correct provider load. Assist in pulling required reporting from CACTUS software, and follow-up with physicians/allied health professionals to assure accuracy and timeliness of information submitted to carriers. Assist with ongoing improvements and development of CHPG delegated credentialing policy and procedures. Understand and engage in National Committee for Quality Assurance (NCQA) requirements, to effectively work with our delegated commercial carriers. Work is reviewed by the Supervisor of the department through reports, conferences and adherence to management guidelines and regulations.
Minimum Education Requirements
High School Diploma
AA or business courses strongly preferred, (without an Associate's degree, an additional 1-3 years direct experience
working experience of commercial payer credentialing)
Minimum Experience Requirements
1-3 years of healthcare-related physician/allied health professionals credentialing experience, business office experience or billing experience preferred
Must have strong organizational, written, verbal, problem solving, and relationship building skills.
Ability to work independently and multi-task
CACTUS software experience preferred/recommended
X Sedentary Work - prolonged periods of sitting and exert/lift up to 10 lbs force occasionally
Important notification to applicants as of Nov. 20, 2014: Effective Jan. 1, 2015, Centura Health will no longer hire tobacco users in Colorado and Kansas. The change to our policy does not apply to associates hired on or before Dec. 31, 2014. Centura Health is an Equal Opportunity Employer, M/F/D/V.
Find your ideal career at Centura Health! With 16 hospitals, physician clinics, hospice services, home care and senior living communities, Centura Health's vast network of care spans Colorado and Western Kansas so you can experience a balanced lifestyle and enjoy a fulfilling career anywhere you want to work, live and play in Colorado. From the fast pace of a Denver-area Level 1 Trauma Center to a... smaller rural or mountain hospital – we proudly offer a more diverse range of work settings and locations than any other health care employer in the state. Centura is an equal opportunity employer.