Under minimal supervision coordinates, verifies, and monitors the Provider Enrollment process for Medicare, Medicaid, and the provider credentialing for other payer applications. Work closely with leader to ensure compliance with regulatory agencies and maintain a working knowledge of statutes and laws that affect the enrollment process. Provides required monthly or quarterly reports to third party payers and internal Denver Health staff. Assists providers in completing all required governmental forms for Medicare and Medicaid in a timely and accurate manner.
1. Collect, verify, and submit information necessary for the enrollment of Physicians and Advanced Practice Providers in third party payer programs, including Medicare, Medicaid and other payers contracted with Denver Health. Contact providers to complete credentialing and re-credentialing applications in a timely manner. 2. Coordinate regularly with the Medical Staff Office through the credentialing processes for gathering accurate and complete information in order to credential all existing practitioners when new payers are contracted via the enrollment systems, including utilization of PECOS, NPPES, and CAQH. Provide Medicare and Medicaid numbers and effective dates to the Medical Staff Office (MSO) via the MD Staff database application. 3. Develop and maintain ongoing standard operating procedures specific to each payer for credentialing new practitioners and maintain or renew credentialing for existing practitioners. Actively identify problems and opportunities for improvement; identify appropriate solutions and involve necessary stakeholders in the implementation process. 4. Maintain working knowledge of Hospital Facility Out-of-State Medicaid enrollment requirements and regulations. Ensure appropriate education and communication is conveyed to organizational stakeholders, including the Clinical Operations, Reimbursement, and MSO Departments. Work with the Director of Reimbursement to validate NPI NPPES accounts and ensure group enrollments are up-to-date and accurate. 5. Accurately and consistently maintain appropriate data collection and filing systems within MD Staff in accordance with NCQA guidelines and MSO's standard operating procedures. Conduct root-cause analysis to identify and resolve provider enrollment issues, while maintaining industry best practices for enrollment to ensure compliance to government rules and regulations. 6. Participates in performance improvement activities; quality improvement and patient safety activities; and promotes good working relationships with all Denver Health staff. 7. Work closely with the leader, Revenue Cycle Manager, and Payer Contract Manager to ensure complete enrollment in payer programs to allow for accurate rosters and timely claim processing. 8. Other duties as assigned
Knowledge, Skills & Abilities
Knowledge, Skills and Abilities 1. Knowledge of TJC, NCQA and CMS credentialing standards preferred. 2. Must be able to work independently and meet schedules and deadlines. 3. Ability to handle multiple tasks, simultaneously. Ability to communicate in a professional and positive manner. Ability to compile and analyze data for various types of reports. Computers and Technology 1. Computer proficiency in Windows, Microsoft Office (i.e. Word, Excel) required 2. Experience using credentialing software (MD Staff) preferred
* High School Diploma or GED (Required) Two years' experience in credentialing or performing relevant functions in an enrollment setting or related healthcare setting. * Associate's Degree
* Experience in credentialing and privileging. (Required)
* Certified Provider Credentialing Specialist * Certified Professional Medical Services Management
Work Type Full time
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, efficient, high-quality academic health care system that is considered a model for the nation. The Denver Health system includes the Rocky Mountain Regional Level I Trauma Center, a 525-bed acute care medical center, Denver's 911 emergency medical response system, 8 family health centers, 15 school-based health centers, the Rocky Mountain Poison and Drug Center, the Denver Public Health Department, an HMO, and The Denver Health Foundation.
As Colorado's primary safety net institution, Denver Health is a mission-driven organization that has provided more than $3.3 billion in care for the uninsured in the last ten years. Denver Health is a leader in performance and quality improvements and remains financially secure, in part, due to its nationally recognized implementation of lean principles in healthcare. Denver Health is a major resource to the community, serving approximately 185,000 individuals and 67,000 children a year.
Located just south of 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 is committed to provide equal treatment and equal employment opportunities to all applicants and employees. Denver Health is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class."
Internal Number: 661
About Denver Health
Take your career to the next level at Denver Health, where we offer a robust benefits package and endless opportunities for growth. Denver Health is a nationally-ranked, locally-trusted, premier healthcare institution located in the heart of Denver, Colorado.Twenty-five percent of all Denver residents, or approximately 150,000 individuals, receive their health care here. We are known as an integrated health care system that encompasses multidisciplinary academic specialties, a community health system, a level I adult trauma center, pediatric emergency and urgent care center home to Denver Public Health and many of the nation’s leaders in medicine.