Delegated Credentialing Specialist Summit Medical Consultants

LLC - 3.2

Greenwood Village, CO Job Details Full-time $32 - $35 an hour 14 days ago Benefits Health savings account AD&D insurance Paid holidays Disability insurance Health insurance Dental insurance 401(k) Flexible spending account Paid time off Employee assistance program Vision insurance 401(k) matching Life insurance Qualifications Healthcare Administration Provider enrollment for medical credentialing CMS Filing State healthcare regulations CMS regulatory compliance Health insurance knowledge Attention to detail NCQA standards Clinical information systems Productivity software Quality audits Regulatory compliance analysis Associate's degree Full Job Description About Us Summit Medical Consultants is a rapidly expanding physician-owned post-acute practice providing exceptional clinical services throughout Colorado. With a focus on delivering compassionate and coordinated care, we collaborate closely with healthcare professionals and our partner facilities to ensure the best outcomes for our patients. At Summit, we value our more than 100 providers and team members, recognizing the important contributions each individual makes to our patients and our organization. We offer a comprehensive benefits package effective the first of the month following your date of hire. Position Overview Summit Medical Consultants is seeking an experienced, detail-oriented Delegated Credentialing Specialist to support our growing delegated credentialing program. This position is responsible for maintaining provider credentialing and enrollment files, coordinating credentialing activities with hospitals, post-acute care facilities, health plans, and external vendors, and ensuring compliance with delegated credentialing agreements and regulatory standards. The Delegated Credentialing Specialist serves as a subject matter expert in delegated credentialing and works closely with internal departments to ensure providers are credentialed accurately and efficiently while maintaining compliance with NCQA, CMS, CAQH, NPPES, payer, and state requirements. This position reports to the Practice Manager and is an individual contributor role with no direct supervisory responsibilities. Work Location In person - Greenwood Village, Colorado (near I-25 and Arapahoe Road) Responsibilities Manage provider credentialing, enrollment, and recredentialing activities in accordance with delegated credentialing agreements and regulatory requirements. Prepare, maintain, and audit provider credentialing files to ensure compliance with NCQA, CMS, CAQH, NPPES, payer, and state standards. Coordinate timely submission of provider credentialing applications to hospitals, post-acute care facilities, health plans, and external vendors. Maintain accurate provider credentialing files, databases, and tracking systems. Monitor provider licenses, DEA registrations, board certifications, malpractice insurance, and other expirable credentials to ensure timely renewals. Coordinate credentialing activities for provider onboarding and offboarding. Maintain provider rosters and communicate provider additions, terminations, and updates to health plans, facilities, and internal departments. Perform quality assurance reviews and support internal and external delegated credentialing audits. Assist with development, maintenance, and implementation of credentialing policies and procedures. Monitor credentialing turnaround times and proactively resolve credentialing issues. Collaborate with Recruiting, Billing, Operations, Clinical Leadership, and external organizations to facilitate provider enrollment and credentialing. Recommend process improvements and technological solutions to improve efficiency and maintain regulatory compliance. Coordinate with Information Technology regarding provider database accuracy and provider system access. Assist with provider access to facility EHR systems and practice applications. Travel to facilities or other Summit Medical Consultants locations as needed. Perform other administrative duties as assigned. Qualifications Required Three (3) to five (5) years of healthcare credentialing or provider enrollment experience. Demonstrated experience with delegated credentialing programs. Strong working knowledge of NCQA, CMS, CAQH, NPPES, payer enrollment, and applicable state regulations. Excellent organizational, analytical, communication, and problem-solving skills. Strong attention to detail and ability to manage multiple priorities independently. Proficiency with credentialing software and Microsoft Office applications. Preferred Associate's or Bachelor's degree in Healthcare Administration or a related field (or equivalent professional experience). Certified Provider Credentialing Specialist (CPCS) certification. Experience with post-acute care, skilled nursing, rehabilitation, long-term care, or hospital credentialing. Benefits 401(k) with immediate employee participation and employer match after six months. Three medical plan options, including one with 100% employer-paid employee coverage. Employer-paid dental and vision coverage for employees. Paid Time Off and six paid holidays. Life insurance. Disability insurance. Flexible Spending Account (FSA). Health Savings Account (HSA). Employee Assistance Program. Additional voluntary benefits. Schedule Full-time, Non-Exempt (Hourly) Monday through Friday 8am to 5pm Overtime may be required and must be approved in accordance with company policy. Work Location This is an in-person position requiring attendance in the Greenwood Village office five (5) days per week.

Pay:

$32.00 - $35.00 per hour

Benefits:

401(k) 401(k) matching AD&D insurance Dental insurance Disability insurance Flexible spending account Health insurance Health savings account Life insurance Paid time off Vision insurance Application Question(s): Will you now or in the future require Summit Medical Consultants to sponsor an employment-based immigration case (such as an H-1B visa)? Do you have at least three (3) to five (5) years of healthcare credentialing or provider enrollment experience, including delegated credentialing? Please describe your experience. This is an in-person position requiring attendance in the Greenwood Village office five (5) days per week. Are you comfortable with this requirement? Ability to

Commute:

Greenwood Village, CO 80112 (Required)

Work Location:

In person