SHIFT: No Weekends SCHEDULE: Full-time Salary Estimate: $49171.20 - $73756.80 / year Learn more about the benefits offered for this job.
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Manager of Credentialing and Provider Relations
Colorado Care Partners
We are seeking a Manager of Credentialing and Provider Relations for our center to ensure that we continue to provide all patients with high quality, efficient care. We are an amazing team that works hard to support each other and are seeking a phenomenal addition like you who feels patient care is as meaningful as we do. We want you to apply now!
We offer you an excellent total compensation package, including competitive salary, excellent benefit package and growth opportunities. We believe in our team and your ability to do excellent work with us. Your benefits include 401k, PTO medical, dental, flex spending, life, disability, tuition reimbursement, employee discount program, employee stock purchase program and student loan repayment. We would love to talk to you about this fantastic opportunity.
Healthcare Corporation of America (HCA) is a community of 94,000 Registered Nurses and 38,000 active physicians. We have over 1,900 facilities ranging from hospitals, freestanding ER’s, ambulatory surgery centers, and urgent care clinics. Our facility based staff continues to raise the bar in patient care. Ten HCA hospitals have been named in IBM Watson Health’s top 100 best-performing hospitals based on patient satisfaction and operational data.
HealthONE® is the largest healthcare system in the metro Denver area with more than 11,000 employees. As part of the HealthONE family, The Medical Center of Aurora, North Suburban Medical Center, Presbyterian/St. Luke’s Medical Center, Rocky Mountain Hospital for Children, Rose Medical Center, Sky Ridge Medical Center, Swedish Medical Center, and Spalding Rehabilitation Hospital work together to provide a higher level of care.
In addition, our family of services includes six hospital free-standing emergency departments and numerous ambulatory surgery centers, occupational medicine clinics, physician practices, imaging centers, and AIRLIFE-DENVER, which provides critical care air and ground transportation across a 10-state region. Beyond the new facilities and the workforce offerings, we also provided $7.7 million to local organizations to fund a variety of programs; and, as one of the top ten corporate philanthropists in the metro area, we at HealthONE contributed more than $1.5 million to charitable organizations in 2018 through cash and in-kind donations.
• The Medical Center of Aurora: Magnet® designated hospital, Level II Trauma Center, 346 licensed beds
• North Suburban Medical Center: Level III Trauma Center, 157 licensed beds
• Presbyterian/St. Luke’s Medical Center & Rocky Mountain Hospital for Children: Level II Trauma Center, 680 licensed beds
• Rose Medical Center: Magnet® designated hospital, Level II Trauma, 422 licensed beds
• Sky Ridge Medical Center: Level II Trauma, 274 licensed beds
• Swedish Medical Center: Level I Trauma, 408 licensed beds
• Behavioral Health and Wellness Center at the Medical Center of Aurora: 120 licensed beds
Colorado Care Partners (CCP) is a Colorado-based Clinically Integrated Network (CIN) and Accountable Care Organization (ACO). Our CIN/ACO network is comprised of more than 320 clinicians to include physicians and advanced practice providers, 6 acute care hospitals and 2 specialty hospitals who have come together in value based care. Our clinical team works collaboratively with our network of internists, family physicians and pediatricians to ensure every patient receives the best medicine at every point in their healthcare journey.
CCP’s goal is to partner with practices in the following areas:
Wellness and prevention
Chronic disease management
Improved patient access to care
Improved collaboration and communication amongst providers across all healthcare settings
Providers who become members of CCP are responsible for demonstrating how they provide high-quality care by adhering to value-based data and benchmarks across diverse care settings. It gives them and their practice an opportunity to create a patient-centered solution that improves patient outcomes while reducing costs.
Patients benefit from coordinated, evidence-based healthcare that allows them to better manage their own health in partnership with CCP providers. While providers and their practices benefit from establishing a more efficient and effective plan of care for all their patients.
The Manager of Provider Relations and Credentialing is responsible for ensuring that each medical office contracted with Practice Health & HealthONE Colorado Care Partners is up to date on their payer contracts, and that they have access to their fee schedules and an understanding of those fee schedules. This position oversees the credentialing staff and obtains the credentialing packets from the offices and manages the credentialing files as well as oversees all customer service questions and complaints. As the Manager of Credentialing this position ensures that all physician files both electronic and paper are up to date. Additionally, this position is responsible for outgoing communications, the website, and plans the educational meeting and their logistics. This position will also conduct practice visits on a regular basis as well as “sell” the overall services of Practice Health and Colorado Care Partners to potential new physicians. Lastly, this position will oversee and collaborate with an outside Credentialing Verification Organization for delegated credentialing services. Credentialing database management will also be required.
• Oversee the credentialing staff • Serve as a liaison between member practices and payers for problem resolution, contract disputes, reimbursement issues, credentialing etc… • Manages incoming phone calls and solves issues for members • Payor Relations and Physician Advocacy with claims, demographic or credentialing disputes • Claims resolution for providers • Office Based Provider Relations - spends a minimum of 50% time meeting with the member medical practices • Coordinates Roster changes and maintains email distribution lists to all member physicians, office staff and HealthONE personnel within Sales Force Marketing or other marketing and communications tools. • Payor meetings • Credentialing backup, oversight and support • Oversee the Credentials & Board Committees • Supervises credentialers including timecards and time off • Answer customer service call about credentialing, payer issues etc. • Assists with newsletters • Assists with website creation and maintenance • Event planning and scheduling • Other duties as assigned • Always be ready for unexpected projects and changes
If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply. We promptly review all applications. If you are highly qualified you will hear from one of our managers. Come unlock the possibilities and apply today!
•5 years healthcare experience in an administrative role in a health system •College degree in business, communications or health care administration preferred •Must have experience in customer service, medical practice management and physician credentialing •Excellent written, verbal, interpersonal communications skills •CPCS Certification preferred •Strong Microsoft skills required •Solid Excel skills (creating, manipulating and maintaining datasets) •Must be highly organized
We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status
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Join our HealthONE family -- the largest healthcare system in the Denver metro area. Eight world-class hospitals. 40+ outpatient facilities. Countless opportunities.HealthONE is an equal opportunity employer.