We are recruiting for a motivated Provider Relations Specialist to join our team! Clinical Operations Admin Job Summary

Under minimal supervision coordinates, monitors and maintains the credentialing and re-credentialing process of 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 and professional practice evaluations while developing and maintaining a working knowledge of the statutes and laws. Assists in the development, planning, and implementation of the credentialing and privileging process, professional practice evaluations and advanced Practice Provider Supervisory Plans. Responsible for the integrity of the credentialing and privileging database and for ensuring the timeliness of credentialing and re-credentialing verifications.

Essential Functions:

• Credentialing and Privileging (5%)


• Facilitates all aspects of credentialing and privileging for initial appointments and reappointments. (10%)


• Process 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. (10%)


• Professional Practice review (10%)


• Collates department/division based data on Medical Staff members (physicians and advanced practice providers) from a variety of data sources, including the EPIC system, the Vizient database, Values Line, and other relevant sources and prepares all reports for Medical Staff FPPE and OPPE. (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 of Service or designee to track and notify when evaluations are due. (10%)


• Notifies the Chief Medical Officer of delinquent reports with greater than 30 days of deficiency. (10%)


• Advance Practice Provider Supervisory Plans (10%)


• Collates and maintains all Supervisory Plans for advanced practice practitioners, as required by State of CO. Completes all in a timely manner to ensure compliance with regulatory deadlines. (10%)


• Maintains plans in a centralized location. (10%)


• Updates DORA of changes to Supervisory roles and supervising physician leaves the institution. (5%)


• Process Improvements and monitoring which include, but are not limited to: (0%)


• Applies working knowledge of the applicable standards, laws, regulations, Medical Staff Bylaws, and Credentialing and Privileging Appointment Policies and Procedures. (0%)


• Actively identifies problems and opportunities for improvement; identifies appropriate solution and involves others in the implementation process. (0%)


• Maintains the confidentiality of all business/work and Medical Staff information. Assists in managing the flow of information between the MSO team, Director of Service, and Chief Medical Officer. Works independently with internal and external colleagues. (0%)


• Participates in performance improvement activities; quality improvement and patient safety activities and promotes good working relationships with all Denver Health staff. (0%)


• Assists in compliance with the accrediting and regulatory agencies (i.e. TJC, NCQA, and CMS) in regards to credentialing and privileging. (0%)


• Ensures that all expirees are reviewed, obtained and managed on a monthly basis according to the rules and policies. (0%)


• 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 and insurance companies. (0%)

Education:

• Bachelor's Degree Required

Work Experience:

• 1-3 years Two years’ experience in credentialing and privileging or related healthcare position Required

Licenses:

• CPMSM-Certified Professional Medical Services Management - NAMSS - Education Advocacy Patient Safety Required

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.

Remote opportunity for residents of Colorado, Illinois, Kentucky, Mississippi, New Hampshire, Ohio, Pennsylvania, South Carolina, Texas, Utah, Virginia, Washington, and Wisconsin Days (United States of America) Regular $24.56 - $33.23 / hr

• 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 Eco Pass (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

• Respect
• Belonging
• Accountability
• Transparency