Manager, Provider Enrollment

We are recruiting for a motivated Manager, Provider Enrollment to join our team!

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Department

Medical Staff Services and Provider Enrollment

Job Summary

Under minimal supervision coordinates, monitors and maintains the Provider enrollments and revalidations for Government Programs, such as Medicare, Medicaid, etc., for the Medical Staff, Advanced Practice Providers and Billable Non-Privileged Providers at Denver Health. Ensures compliance with the accrediting and regulatory agencies (i.e., TJC, NCQA, and CMS) in regards to payor enrollment while developing and maintaining a working knowledge of the statues and laws. Assists in the development, planning, and implementation of the provider enrollment process. Responsible for the integrity of the enrollment database and for ensuring the timeliness of enrollments for optimal payment collection.

Essential Functions:

• Build, train, manage and lead a team of Provider Enrollment Specialists, who will be the point of contact for Medicare, Medicaid and Dental Contracts. (20%)
• Serve as the subject matter expert on government relations, particularly Medicaid and Medicare, for Enterprise and Mid-Market clients, providing clear communication and expert guidance on complex regulatory matters. (15%)
• Has and maintains a deep understanding of PE team processes, workflows, and tools, and drive workflow improvements. (5%)
• Ensure that all enrollment and credentialing activities comply with government standards and internal policies. (5%)
• Identify opportunities to improve the efficiency of the enrollment process, reducing turnaround times and increasing first-time approval rates. (5%)
• Implement and monitor process improvements to streamline operations and enhance service delivery. (5%)
• Resolve complex provider enrollment issues by coordinating with internal and external stakeholders (5%)
• Continuously learn and implement industry best practices to enhance efficiency, growth, and client outcomes (5%)
• Design and conduct training on the provider enrollment process and process improvement initiatives (5%)
• Lead communication with Enterprise and Mid-Market clients, managing regular and ad hoc client calls to ensure smooth support (5%)
• Work with the Revenue Cycle Management and the Payor Contracting team on any patterns of claim denials that may be related to Credentialing or Contracting (5%)
• Oversee the data entry into departmental software, document sorting, and application submission (5%)
• Build out performance metrics for the provider enrollment team (5%)
• Partner with the Director of Medical Staff and Provider Enrollment to run time studies of credentialing onboarding and provider enrollment workflows to identify areas for improvement (5%)
• Partner with the necessary teams to build new dashboards and reports to help our Provider Enrollment organization run most efficiently (5%)

Education:

• Post High School Diploma or Certificate Program Bachelor’s degree or 6 years of experience in the field in lieu of a degree Required and
• Post High School Diploma or Certificate Program PESC Certification Required

Work Experience:

• 4-6 years Five years experience in Enrollment for Government Programs for the Medical Staff and Billable Non-Privileged providers. Required

Licenses:

Knowledge, Skills and Abilities:

• Computer proficiency in Windows, Microsoft Office, and Internet
• Knowledge of TJC, NCQA and CMS credentialing & enrollment 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
• MD Staff knowledge in enrollment

Shift

Work Type

Regular

Salary

$78,802.00 - $118,203.00 / 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.

Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community.

Applicants will be considered until the position is filled.

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