Provider Enrollment Specialist

This is a fully remote position, open to applicants in Colorado.

📋 Description

• Coordinates, monitors, and manages enrollments for Medicare, Medicaid, and Dental Plans for the Medical Staff and Advanced Practice Providers with minimal supervision.

• Ensures adherence to the standards set by accrediting and regulatory bodies (such as TJC, NCQA, and CMS) regarding credentialing while developing and maintaining a comprehensive understanding of the relevant statutes and laws.

• Facilitates the enrollment process of professional providers with various payers for professional services and governmental reimbursements through Medicare and Medicaid.

• Reviews data related to provider credentialing and/or recredentialing/revalidation for accuracy based on licensing requirements and the specifications of various insurers and government payers.

• Completes application processes promptly according to payer and government-specific formats.

• Consistently follows up on enrollment and/or recredentialing/revalidation statuses until completion.

• Maintains the systems and applications utilized in the enrollment processes.

• Completes provider payer enrollment, credentialing, and recredentialing with all identified payers in a timely manner.

• Handles sensitive and confidential information regarding professional providers.

• Resolves enrollment issues by collaborating with physicians, non-physicians, office staff, management, contracting entities, insurers, and other relevant parties.

• Cultivates positive relationships with providers.

• Actively explains and informs providers and practice/office managers about the submission requirements for credentialing and recredentialing processes, emphasizing the importance of compliance.

• Gathers updated provider information from various sources, including provider offices, state licensing boards, malpractice insurance companies, and residency training programs.

• Identifies and resolves issues related to primary source verification by interpreting, analyzing, and researching data.

• Proactively acquires updated provider credentialing data before expiration.

• Creates, develops, and maintains relevant matrices and/or utilizes departmental software that supports enrollment functions.

• Completes all additions, updates, and deletions efficiently.

• Assists with new provider onboarding processes related to enrollment.

• Provides updates to on-site practice management staff and others regarding any changes to requirements for credentialing individual providers based on government and commercial payer processes.

• Proactively communicates any changes regarding contracting as they relate to enrollment and operations.

• Shares updated payer enrollment information, including payer provider numbers, with practice operations promptly while fostering teamwork and relationships with departments, vendors, and others.

• Develops databases and spreadsheets to track organization providers.

• Ensures that data is accessible and transparent for executive inquiries or other information requests as deemed necessary by management.

⛳️ Requirements

• High School Diploma or GED.

• Required or PESC Certification.

• 4-6 years of experience in credentialing and enrollments with Payors, Medicare, Medicaid, and Dental Payors is required, or less than 1 year with PESC Certification.

• Knowledge of federal and Colorado statutes, legislative initiatives, and regulations, along with federal, state, and local policies.

• Familiarity with TJC, NCQA, and/or CMS credentialing standards.

• Proficient in Microsoft Word, Excel, and Outlook.

• Ability to simultaneously coordinate and manage multiple functions, programs, and tasks at various stages of completion.

• Capability to interpret and apply policies and procedures.

• Skilled in delivering excellent customer service.

• Ability to communicate in a professional and positive manner.

• Consistently implement program, department, and organizational policies and procedures.

• Must be capable of working independently and meeting schedules and deadlines. Knowledge of MD Staff provider enrollment is preferred.

🏝️ Benefits

• Paid time off starting at 28 days per year, which includes vacation, personal/sick days, and 7 holidays.

• 100% paid parental leave for up to 6 weeks.

• Immediate eligibility for retirement plans with employer contributions of up to 9.5%.

• Comprehensive medical, dental, and vision plans, in addition to employer-paid disability and life insurance.

• Extensive well-being programs, including an on-site employee fitness center located on the Denver Health main campus and the nationally recognized RESTORE Center.

• Free RTD EcoPass for public transportation.

• Childcare discount programs and exclusive perks with major brands, travel, and more.

• Tuition reimbursement and assistance.

• Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways.

• A professional clinical advancement program and shared governance.

• Eligible employer for Public Service Loan Forgiveness (PSLF), along with free student loan coaching and assistance navigating the PSLF program.

• Eligible employer for National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC).