Provider Enrollment Specialist II

We are recruiting for a mission-driven Provider Enrollment Specialist II 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.


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 (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 team work 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 High School Diploma or equivalent required Required or
• PESC Certification Required

Work Experience :

• 4-6 years Of experience in credentialing and enrollments with Payors, Medicare, Medicaid and Dental Payors Required or
• less than 1 year PESC Certification

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
• Ability to consistently implement program, department and organizational policies and procedures.
• Must be able to work independently and meet schedules and deadlines
• MD Staff provider enrollment knowledge is preferred

Shift
Days (United States of America)

Work Type
Regular

Salary
$24.33 - $34.06 / hr

Benefits

At Denver Health, we take care of the people who take care of our community. Our benefits are built to support your life, your family, and your future - with generous paid time off, fully paid parental leave, exceptional retirement contributions, comprehensive health coverage, and nationally recognized well-being programs. We invest in your growth through tuition assistance, career advancement pathways, and professional development - while also offering meaningful financial advantages through loan forgiveness eligibility and employer contributions. When you join Denver Health, you're joining a mission-driven organization that invests in you.


Here is a small list of our benefit programs:

• 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
• Tuition reimbursement & assistance
• 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

About Denver Health

Denver Health is an integrated, high-quality academic healthcare system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver's 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, the Public Health Institute at Denver Health, Denver Health Medical Plan and Denver Health Foundation.


As Colorado's primary, and essential, safety-net healthcare system, Denver Health is a mission-driven organization that has provided millions in uncompensated care for the uninsured each 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. All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made. Applicants will be considered until the position is filled.