Job description

CU Medicine is dedicated to providing healthcare and administrative support to the University of Colorado School of Medicine’s nearly 3,000 providers and is affiliated with the leading medical institutions in the West. Located adjacent to the Anschutz Medical Campus, one of the largest and most advanced academic medical campuses in the country, CU Medicine offers a variety of administrative, technical and healthcare support career opportunities and serves as a resource for patients and physicians.

We are seeking a highly motivated Medical Credentialing Coordinator to join our team.

This job offers a primarily remote work structure once an individual is fully trained and competent in the job. On-site work is required as dictated by business need with the potential for on-site work approximately 3-4 days per month.

PLEASE NOTE: The individual hired for this position will be required to be fully vaccinated against COVID-19 or furnish proof of an approved medical or religious exemption. In the event you are contacted by CU Medicine regarding your candidacy, please direct any questions to the recruiter at that time.

The Credentialing Coordinator will credential and/or re-credential CU School of Medicine (CU SOM) employed faculty under the CU Medicine Practice agreement. The individual in this position will ensure NCQA and URAC guidelines are followed to ensure high quality care is provided to members of the Managed Care Organization (MCO)/commercial panels. This credentialing process is key to facilitate billing and collecting through CU MEDICINE for services provided by faculty to MCO health plan members.

The Credentialing Coordinator will:

• Manage daily processing of CHCPCA applications submitted by various departments.
• Approve submissions to begin the credentialing processing or deny submissions to request missing information via Salesforce.
• Submit completed applications to the Credentialing Verification Organization (CVO) through a Start Work File report.
• Monitor daily assessment of the receipt, status, and completed applications by viewing reports on the CVO portal while comparing to Salesforce reports tracking of processes.
• Ensure each file has all required NCQA primary source verifications (PSV) performed, supporting documents, and/or explanations from the practitioner.
• Analyze each file for completeness, problem issues (i.e., litigation reviews, sanction information, etc.) and ensure confidentiality of such information.
• Monitor the Credentialing Verification Organization (CVO) for complete PSV info, check-in PSV info in each file, and record all entries in Salesforce.
• Coordinate the agenda for the three CU MEDICINE Credentialing Committee meetings held monthly intended for review and approval/denial of all files.
• Perform all follow-up required from the meetings and any other related activities (i.e. data entry, filing, etc.)
• Perform Adobe Pro functions for the electronic file to be filed in the Egnyte repository.
• Distribute spreadsheets and credentialing database reports of approvals and/or terminations of CU Medicine practitioners to all MCOs on a monthly basis.
• Serve as a resource to all internal and external customers for all issues related to the credentialing process, acquiring knowledge of the nuances associated with credentialing for a Practice Group for a School of Medicine.
• Ensure confidentiality and accuracy of the Credentialing database in Salesforce.
• Facilitate and/or participate in all MCO annual audits.
• Demonstrate willingness to be a team player while assisting with all credentialing processes when the volume increases during the annual 7/1 academic year season.

Requires a high school diploma or equivalent and prior experience in a professional office setting. Must have extensive knowledge of the NCQA and URAC guidelines/standards. The ideal candidate will demonstrate a willingness to train on and learn the Salesforce database and be able to operate general office equipment (i.e. PCs, copiers, fax machines, etc.). Must possess clear and concise verbal and written communication skills needed to interface effectively with both internal and external contacts.

TO APPLY FOR THIS POSITION, please click on the direct apply link below (Job #703)

All applications MUST be submitted via our website.

CU Medicine is dedicated to ensuring a safe and secure environment for our staff and visitors. To assist in achieving that goal, we conduct background investigations for all prospective employees prior to their employment. We are an equal opportunity employer.
The listed pay range (or hiring rate) represents CU Medicine’s good faith and reasonable estimate of the range of possible compensation at the time of posting and is based on evaluation of competitive market data.
A variety of factors, including but not limited to, internal equity, experience, and education will be considered when determining the final offer.
CU Medicine provides generous leave, health plans and retirement contributions which take your total compensation beyond the number on your paycheck. Find information about our benefits here

CU Medicine supports a Tobacco Free Workplace Environment which prohibits smoking and the use of tobacco products on CU Medicine property, Anschutz Medical Campus and adjacent business locations.

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