Payer Enrollment Coordinator

Here, it's different. Come join us.

Children's Hospital Colorado has defined and delivered pediatric healthcare excellence for more than 100 years.

Here, the nation's brightest nurses, physicians, scientists, researchers, therapists, and care providers are creating the future of child health. With an optimist's outlook, a trailblazing spirit, and a celebrated history, we're making new strides every day.

We've been Magnet-designated four times by the American Nurses Credentialing Center and are consistently recognized among the best of the best pediatric hospitals with #1 rankings in Colorado and the region by U.S. News & World Report.

As a national leader in pediatric care, we serve children and families from all over the nation. Our System of Care includes four pediatric hospitals, 11 specialty care centers, 1,300+ outreach clinics and more than 10,000 healthcare professionals representing the full spectrum of pediatric care specialties.

Here, we know it takes all of us, every role, to deliver the best possible care to each child and family we treat.

That's why we build our teams toward a foundation of equity in access, advancement, and opportunity. We know teams of individuals with different identities and backgrounds can nurture creativity and innovation. We know we can see, treat, and heal children better when our team reflects the diversity of our patient population. We strive to attract and retain diverse talent because we know a truly inclusive and equitable workforce will help us one day realize our most basic calling: to heal every child who comes through our doors.

A career at Children's Colorado will challenge you, inspire you, and motivate you to make a difference in the life of a child. Here, it's different.

The Payer Enrollment Coordinator is responsible for assisting in facilitating and maintaining the enrollment process for delegation, facility, and provider enrollments with government and commercial insurance plans, ensuring that all necessary documentation is completed accurately and in a timely manner. Collaborates closely with various stakeholders to ensure seamless communication and coordination throughout the enrollment process. Responsible for preparing, submitting, and tracking enrollment applications and supporting documentation for the purpose of enrolling facility and billing health care providers with payers.

Department Name: Medical Staff Services
Job Status: 40 hours per week, eligible for benefits
Shift: Days. Monday - Friday, 8:00am - 4:30pm

*This is a remote, work-from-home position

• Education: High School Diploma or equivalent.

POPULATION SPECIFIC CARE

• No direct patient care.

ESSENTIAL FUNCTIONS

An employee in this position may be called upon to do any or all the following essential functions. These examples do not include all the functions which the employee may be expected to perform.

• The following will be maintained in compliance with the Children's Hospital Medical Staff Bylaws, applicable policies and procedures and delegated credentialing contracts, as well as Joint Commission (TJC), Centers for Medicare and Medicaid Services (CMS), The National Committee for Quality Assurance (NCQA), or other federal and state regulatory/accreditation body regulations.
• Manages and tracks the enrollment application process to promote compliance, process enhancement, and efficiency.
• Makes leadership aware of any potential derogatory issues identified during the credentialing process and works in collaboration with stakeholders to document/resolve the issue.
• Works closely with stakeholders to expedite completion of forms and requirements including obtaining signatures, locating required documentation.
• Researches and resolves facility and provider enrollment issues.
• Maintains the timelines on enrollments, communicates with providers, clarifies payer information requirements, and maintains a strict level of confidentiality for all matters pertaining to facility and provider credentials.
• Follows-up with payers regarding facility and provider enrollment status and maintains documentation and reporting regarding the enrollment process.
• Manages the completion and submission of facility and provider enrollment applications.
• Monitors facility and provider licensing/certification expiration dates and works with providers and clients to ensure timely renewals are completed.
• Researches and understands health plan credentialing requirements to ensure compliance with the submission of credentialing materials.
• Maintains facility and provider enrollment information within the credentialing database; CAQH, internal credentialing software and any other website that needs to be maintained.
• Assists in audits and submission of required reporting for delegation, facility, and provider enrollment. Provides regular status reports and timely appropriate escalation of issues of provider insurance enrollment/participation.
• Responds to internal and external inquiries on routine enrollment matters.

SCOPE & LEVEL

• Guidelines: Trains in the field and assists higher level personnel to acquire learning through practical experience.
• Complexity: Performs routine and/or basic tasks common to the field. Procedures, methods, and techniques to be used are well established with options to be considered well defined. Tools, work aids, and materials to be used are specified.
• Decision Making: Duties assigned are primarily routine, repetitive, and restricted in intricacy with little or no discretion in how they are carried out.
• Communications: Contacts with team members, clients or the public where factual information relative to the organization or its functions are received, relayed, or a service rendered according to established procedures or instructions.
• Supervision Received: Under close supervision, the employee receives training to develop skills and abilities in a specific line of work or general occupational area. Work product is subject to close, continuous inspection.

• Audio-Visual: Color Discrimination: Fair
• Audio-Visual: Depth Perception: Fair
• Audio-Visual: Far Vision: Fair
• Audio-Visual: Hearing: Fair
• Audio-Visual: Near Vision: Good
• Use of Hands/Feet: Both Hands - Precise Motor Function (Or Fine Manipulation)

WORK ENVIRONMENT

• Exposure: Exposure to infectious diseases: Occasional.
• Exposure: Exposure to skin irritations: Occasional.
• Mental and Emotional Requirements: Independent discretion/decision making.
• Mental and Emotional Requirements: Works with others effectively.
• Mental Stress: multi-tasking, meeting deadlines, prioritizing

It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation. Be aware that none of the questions are intended to imply illegal preferences or discrimination based on non-job-related information.

The position is expected to stay open until the posted close date. Please submit your application as soon as possible as the posting is subject to close at any time once a sufficient pool of qualified applicants is obtained.

Here, you matter. As a Children's Hospital Colorado team member, you will receive a competitive pay and benefits package designed to take care of your needs that includes base pay, incentives, paid time off, medical/dental/vision insurance, company provided life and disability insurance, paid parental leave, 403b employer match (retirement savings), a robust wellness program, and access to professional development tools, including an education benefit to help you advance your career.

As part of our Total Rewards package, Children's Colorado offers an annual employee bonus program that rewards eligible team members based on organizational performance. If organizational goals are met for the year, the bonus is paid out the following April.

Children's Colorado delivers annual base pay increases to eligible team members based on their performance over the previous year.