Credentialing Specialist I

Denver Health
tuition reimbursement, retirement plan
United States, Colorado, Denver
601 Broadway (Show on map)
Jan 22, 2025
We are recruiting for a motivated Credentialing Specialist I to join our team! We are here for life's journey. Where is your life journey taking you? Being the heartbeat of Denver means our heart reflects something bigger than ourselves, something that connects us all: Humanity in action, Triumph in hardship, Transformation in health. Department Medical Staff Services and Provider Enrollment Job 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. Essential Functions: Facilitates 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. (65%) Applies working knowledge of the applicable standards, laws, regulations, Medical Staff Bylaws, and Credentialing and Privileging Appointment Policies and Procedures. (10%) Monitors and tracks performance assessments, and competency evaluations for Focused and Ongoing evaluations for the Medical Staff and Advanced Practice Providers. Works closely with the Director's of Service or designee to track and notify when evaluations are due. (10%) Responsible for the accuracy and integrity of the credentialing and privileging database system. Tasks are performed to completion with minimal errors and are accurate, thorough, and timely (10%) 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. (5%) Education: High School Diploma or GED Required Work Experience: 1-3 years Three years' experience in credentialing and privileging in Medical Staff Required CPCS or CPMSM Preferred. If hired without certification, must be able to obtain within 3 years Required Licenses: Knowledge, Skills and Abilities: Knowledge of TJC, NCQA and CMS credentialing standards preferred. 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. Computer proficiency in Windows Microsoft Office Suites Internet Browser, i.e., Chrome, Internet Explorer, etc. Shift Days (United States of America) Work Type Regular Salary $23.15 - $31.32 / hr 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). Denver Health values the unique ideas, talents and contributions reflective of the needs of our community. For more about our commitment to diversity visit: https://www.denverhealth.org/for-professionals/careers/diversity-and-inclusion Applicants will be considered until the position is filled.