Credentialing Coordinator at HealthOne Colorado Care Partner in Denver, Colorado

Job Description:

DESCRIPTION SHIFT: No Weekends

SCHEDULE: Full-time

CREDENTIALING COORDINATOR
HEALTHONE DIVISION
COLORADO CARE PARTNERS

WE ARE SEEKING A CREDENTIALING COORDINATOR FOR OUR CENTER TO ENSURE THAT WE CONTINUE TO PROVIDE ALL PATIENTS WITH HIGH QUALITY, EFFICIENT CARE. WE ARE AN AMAZING TEAM THAT WORKS HARD TO SUPPORT EACH OTHER AND ARE SEEKING A PHENOMENAL ADDITION LIKE YOU WHO FEELS PATIENT CARE IS AS MEANINGFUL AS WE DO. WE WANT YOU TO APPLY NOW!

WE OFFER YOU AN EXCELLENT TOTAL COMPENSATION PACKAGE, INCLUDING COMPETITIVE SALARY, EXCELLENT BENEFIT PACKAGE AND GROWTH OPPORTUNITIES. WE BELIEVE IN OUR TEAM AND YOUR ABILITY TO DO EXCELLENT WORK WITH US. YOUR BENEFITS INCLUDE 401K, PTO MEDICAL, DENTAL, FLEX SPENDING, LIFE, DISABILITY, TUITION REIMBURSEMENT, EMPLOYEE DISCOUNT PROGRAM, AND EMPLOYEE STOCK PURCHASE PROGRAM. WE WOULD LOVE TO TALK TO YOU ABOUT THIS FANTASTIC OPPORTUNITY.

HEALTHCARE CORPORATION OF AMERICA (HCA) IS A COMMUNITY OF 94,000 REGISTERED NURSES AND 38,000 ACTIVE PHYSICIANS. WE HAVE OVER 1,900 FACILITIES RANGING FROM HOSPITALS, FREESTANDING ER'S, AMBULATORY SURGERY CENTERS, AND URGENT CARE CLINICS. OUR FACILITY BASED STAFF CONTINUES TO RAISE THE BAR IN PATIENT CARE. TEN HCA HOSPITALS HAVE BEEN NAMED IN IBM WATSON HEALTH'S TOP 100 BEST-PERFORMING HOSPITALS BASED ON PATIENT SATISFACTION AND OPERATIONAL DATA.

HealthONE(R) is the largest healthcare system in the metro Denver area with more than 11,000 employees. As part of the HealthONE family, The Medical Center of Aurora, North Suburban Medical Center, Presbyterian/St. Luke's Medical Center, Rocky Mountain Hospital for Children, Rose Medical Center, Sky Ridge Medical Center, Swedish Medical Center, and Spalding Rehabilitation Hospital work together to provide a higher level of care.

IN ADDITION, OUR FAMILY OF SERVICES INCLUDES SIX HOSPITAL FREE-STANDING EMERGENCY DEPARTMENTS AND NUMEROUS AMBULATORY SURGERY CENTERS, OCCUPATIONAL MEDICINE CLINICS, PHYSICIAN PRACTICES, IMAGING CENTERS, AND AIRLIFE-DENVER, WHICH PROVIDES CRITICAL CARE AIR AND GROUND TRANSPORTATION ACROSS A 10-STATE REGION. BEYOND THE NEW FACILITIES AND THE WORKFORCE OFFERINGS, WE ALSO PROVIDED $7.7 MILLION TO LOCAL ORGANIZATIONS TO FUND A VARIETY OF PROGRAMS; AND, AS ONE OF THE TOP TEN CORPORATE PHILANTHROPISTS IN THE METRO AREA, WE AT HEALTHONE CONTRIBUTED MORE THAN $1.5 MILLION TO CHARITABLE ORGANIZATIONS IN 2018 THROUGH CASH AND IN-KIND DONATIONS.

* THE MEDICAL CENTER OF AURORA: MAGNET(R) DESIGNATED HOSPITAL, LEVEL II TRAUMA CENTER, 346 LICENSED BEDS
* NORTH SUBURBAN MEDICAL CENTER: LEVEL III TRAUMA CENTER, 157 LICENSED BEDS
* PRESBYTERIAN/ST. LUKE'S MEDICAL CENTER & ROCKY MOUNTAIN HOSPITAL FOR CHILDREN: LEVEL II TRAUMA CENTER, 680 LICENSED BEDS
* ROSE MEDICAL CENTER: MAGNET(R) DESIGNATED HOSPITAL, LEVEL II TRAUMA, 422 LICENSED BEDS
* SKY RIDGE MEDICAL CENTER: LEVEL II TRAUMA, 274 LICENSED BEDS
* SWEDISH MEDICAL CENTER: LEVEL I TRAUMA, 408 LICENSED BEDS
* SPALDING REHABILITATION HOSPITAL: 78 LICENSED BEDS
* BEHAVIORAL HEALTH AND WELLNESS CENTER AT THE MEDICAL CENTER OF AURORA: 120 LICENSED BEDS

COLORADO CARE PARTNERS (CCP) IS A COLORADO-BASED CLINICALLY INTEGRATED NETWORK (CIN) AND ACCOUNTABLE CARE ORGANIZATION (ACO). OUR CIN/ACO NETWORK IS COMPRISED OF MORE THAN 320 CLINICIANS TO INCLUDE PHYSICIANS AND ADVANCED PRACTICE PROVIDERS, 6 ACUTE CARE HOSPITALS AND 2 SPECIALTY HOSPITALS WHO HAVE COME TOGETHER IN VALUE BASED CARE. OUR CLINICAL TEAM WORKS COLLABORATIVELY WITH OUR NETWORK OF INTERNISTS, FAMILY PHYSICIANS AND PEDIATRICIANS TO ENSURE EVERY PATIENT RECEIVES THE BEST MEDICINE AT EVERY POINT IN THEIR HEALTHCARE JOURNEY.

CCP'S GOAL IS TO PARTNER WITH PRACTICES IN THE FOLLOWING AREAS:

WELLNESS AND PREVENTION
CHRONIC DISEASE MANAGEMENT
IMPROVED PATIENT ACCESS TO CARE
IMPROVED COLLABORATION AND COMMUNICATION AMONGST PROVIDERS ACROSS ALL HEALTHCARE SETTINGS
PROVIDERS WHO BECOME MEMBERS OF CCP ARE RESPONSIBLE FOR DEMONSTRATING HOW THEY PROVIDE HIGH-QUALITY CARE BY ADHERING TO VALUE-BASED DATA AND BENCHMARKS ACROSS DIVERSE CARE SETTINGS. IT GIVES THEM AND THEIR PRACTICE AN OPPORTUNITY TO CREATE A PATIENT-CENTERED SOLUTION THAT IMPROVES PATIENT OUTCOMES WHILE REDUCING COSTS.

PATIENTS BENEFIT FROM COORDINATED, EVIDENCE-BASED HEALTHCARE THAT ALLOWS THEM TO BETTER MANAGE THEIR OWN HEALTH IN PARTNERSHIP WITH CCP PROVIDERS. WHILE PROVIDERS AND THEIR PRACTICES BENEFIT FROM ESTABLISHING A MORE EFFICIENT AND EFFECTIVE PLAN OF CARE FOR ALL THEIR PATIENTS.

The Credentialing Coordinator is responsible for ensuring that each medical office contracted with Practice Health and Colorado Care Partners (CCCP) is up to date on their payer contracts, and that that they have access to their fee schedules and an understanding of those fee schedules. This position obtains the credentialing packets from the offices and manages the credentialing files as well as answers any customer service questions and complaints. As Credentialing Coordinator, this position ensures that all physician files, both electronic and paper, are up to date. This position acts as a liaison between the health plans and practice (or provider) with the ultimate goal of adding (or removing) each individual provider and corresponding Tax Identification Number or (TIN) to the Practice Health group, health plan contracts. Responsible for provider services functions including outreach, provider credentialing and the configuration of contracts and provider support. This position is an outward face of its clients such as Practice Health and CCP and works collaboratively with all Physician Members and their office staff. The Credentialing Coordinator will meet with all assigned practices at least once per year either telephonically or in person to ensure all customer service needs are being met.

* Gather documents required to initiate credentialing and configuration of a member's health plan contracts.
* Serve as a liaison between member practices and payers for problem resolution, contract disputes, reimbursement issues, credentialing etc.
* \\"Update\\" health plans with additions, demographic changes and terminations applicable to Practice Health contracts.
* Follow up with health plans monthly to request effective dates and supply additional documentation to support loading to Practice Health contracts.
* Manage CAQH (Council for Affordable Quality Health Care) profiles for approximately 300 providers; re-attest every 90 days, upload renewed documents and communicate with practices regarding demographic updates and other applicable payer credentialing sites.
* Facilitate physician fee schedule configuration through the messenger model process on behalf of individual member practices
* Answer customer service call about credentialing, payer issues etc.
* Initiate Credentialing Fee invoicing and collection of membership dues through QuickBooks
* Payor Relations and Physician Advocacy with claims, demographic or credentialing disputes
* Coordinates Roster changes and maintains email distribution lists to all member physicians, office staff and HealthONE personnel within Sales Force Marketing or other marketing and communications tools.

We are committed to:

Providing an inclusive work environment where everyone is treated with fairness, dignity and respect.
Recruiting and retaining a diverse staff reflective of the patients and communities we serve.
Equal employment opportunities are provided to all employees and applicants for employment without regard to race, color, religion, gender, national origin, citizenship, age, disability, sexual orientation, genetic information, gender identity, protected veteran status, or any other legally protected category in accordance to applicable federal, state, or local laws.