We are recruiting for a motivated Lead Credentialing Specialist to join our team!
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Department
Medical Staff Services and Provider EnrollmentJob Summary
Under minimal supervision coordinates, monitors and maintains the credentialing and re-credentialing process 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. Assists in the development, planning, and implementation of the credentialing and privileging process. Responsible for the integrity of the credentialing and privileging database and for ensuring the timeliness of credentialing and re-credentialing verifications. Oversees a team of credentialing specialists.
Essential Functions:
Credentialing ? Oversees and participates in all aspects of credentialing and privileging for initial appointments and reappointments. Processes initial appointments and reappointments for assigned Medical Staff and Advanced Practice Providers in a timely manner and tracks the application from time of receipt to Board approval. The supervisor will not have the same amount of providers to oversee and maintain as the remainder of the Credentialing Specialists/Coordinators, but will keep oversight of all files moving to the approval process. ? Monitors all incoming privilege packets, applications, and credentialing records for optimal distribution to facilitate timely and accurate retention of documentation. Review and report on all staff and department credentialing and privileging each month. (40%)
Compliance and Auditing ? Applies working knowledge of the applicable standards, laws, regulations, Medical Staff Bylaws, and Credentialing and Privileging Appointment Policies and Procedures ? Responsible for the accuracy and integrity of the credentialing and privileging database system, creating uniform and maintainable work loads for all Coordinators and self. Ensuring that tasks are performed to completion with minimal errors and are accurate, thorough, and timely ? Performs complete file reviews for delegated credentialing audits. Validates that all required credentialing elements are complete and accurate. Provides all necessary documentation for all delegated contracts with insurance companies ? Audits 1-2 files a week of each Credentialing Specialist/Coordinator, to ensure staff are all following department guidelines and are routine in entry as directed by department leadership ? Identifies problems or opportunities for improvement, formulates solutions, involve others in the implementation as necessary and required. ? Applies working knowledge of the applicable standards, laws, regulations, Medical Staff Bylaws, and Credentialing and Privileging Appointment Policies and Procedures. (30%)
Team Oversight ? Works with the Director of the Department in the oversight and day to day work and questions of the Credentials Specialists/Coordinators of the department. ? Assists in the training and development of new Specialists/Coordinators to the team ? Sets clear expectations for staff by developing job specific customer service expectations and behaviors for each position supervised; clearly communicates expectations to each employee and establishes the expectations as job requirements and performance evaluation components; delegates responsibility/authority whenever possible (30%)
Education:
No High School Diploma and/or No GED Graduation from High School or equivalent required. Bachelors Preferred Required
Work Experience:
4-6 years Five years experience in credentialing and privileging for the Medical Staff. Required and
1-3 years MD Staff software Experience Required
Licenses:
Knowledge, Skills and Abilities:
Computer proficiency in Windows, Microsoft Office, and Internet
Knowledge of TJC, NCQA and CMS credentialing standards
Ability to handle multiple tasks, simultaneously
Ability to interpret and apply policies and procedures
Ability to communicate in a professional and positive manner
Must be able to work independently and meet schedules and deadlines
Shift
Days (United States of America)
Work Type
Regular
Salary
$60,314.00 - $87,695.00 / yr
Benefits
Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans
Free RTD EcoPass (public transportation)
On-site employee fitness center and wellness classes
Childcare discount programs & exclusive perks on large brands, travel, and more
Tuition reimbursement & assistance
Education & development opportunities including career pathways and coaching
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
Our Values
Respect
Belonging
Accountability
Transparency
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, high-quality academic health care 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, a Public Health Institute, an HMO and The Denver Health Foundation.
As Colorado?s primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.
Located near 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).
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.Denver Health is an Equal Opportunity Employer At Denver Health we pride ourselves on our commitment to diversity. Equal opportunity is a fundamental principle of Denver Health. As an equal opportunity employer, Denver Health is committed to recruit, hire, promote and administer all human resource actions in a non-discriminatory manner. Denver Health is committed to providing equal opportunities in all business practices and to all persons regardless of age, race, color, national origin, genetic information, religion, sex, pregnancy, disab...ility, sexual orientation, gender identity, gender expression, marital status or veteran status (collectively “protected status”). Denver Health strives to maintain a work environment that is free from unlawful harassment and discrimination and will not tolerate any such conduct by employees or directed at employees within the scope of their employment. Read the full Human Resources Employee Principles and Practices policy.