Provider Enrollment Specialist

Denver Health

Provider Enrollment Specialist coordinating Medicare and Medicaid enrollments for medical staff at Denver Health. Ensuring compliance with regulatory agencies and maintaining relations with providers.

Posted 7/20/2026full-timeRemote • Colorado • 🇺🇸 United StatesMid-LevelSenior💰 $24 - $34 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in provider enrollment and credentialing processes, ensuring compliance with TJC, NCQA, and CMS standards. Proficient in managing sensitive information and maintaining positive relationships with providers while utilizing Microsoft Office tools for data management.

Highest-signal resume keywords

Credentialing ExperienceMedicare EnrollmentMedicaid EnrollmentPESC CertificationKnowledge of TJC, NCQA, and CMS Standards

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Provider EnrollmentCredentialingData ManagementRegulatory ComplianceApplication Processing

Soft Skills

Excellent Customer ServiceProfessional CommunicationProblem SolvingCollaborationTime Management

Tools & Technologies

Microsoft WordMicrosoft ExcelMicrosoft OutlookDepartmental Software

Certifications & Qualifications

PESC Certification

Industry Keywords

MedicareMedicaidDental PlansProvider CredentialingAccrediting Agencies

About the role

Key responsibilities & impact

Under minimal supervision coordinates, monitors and maintains Medicare, Medicaid and Dental Plans enrollments for 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 while developing and maintaining a working knowledge of the statues and laws
Coordinates and facilitates the enrollment of professional providers with various payers for professional services and governmental reimbursement through Medicare and Medicaid
Reviews provider credentialing and/or recredentialling/revalidation data for accuracy based on licensing requirements and various insurer and government payer requirements
Completes timely application processes based on payer and government specific formats
Continually follows up on enrollment and/or recredentialling/revalidations statuses until complete
Maintains systems/applications used in the enrollment processes
Completes provider payer enrollment/credentialling and recredentialing with all identified payers in a timely manner
Handles highly sensitive and confidential information regarding professional providers
Resolves enrollment issues through collaboration with physicians, non-physicians, office staff, management, contracting, insurers, and others as identified
Maintains positive working relationships with providers
Plays an active role in explaining and informing providers and practice/office managers of the submission requirements for credentialing/recredentialing processes, stressing the importance of compliance with these processes
Obtains updated provider information from various sources including provider offices, state licensing boards, malpractice insurance companies, residency training programs, etc
Identified and resolved problems with primary source verification elements by interpreting, analyzing, and researching data
Proactively obtains updated provider credentialing data prior to expiration
Creates, develops, and maintains applicable matrices and/or utilizes departmental software that supports the enrollment functions
Completes all additions, updates, and deletions
Supports new provider onboarding processes related to enrollment
Provides updates to on-site practice management staff and others with any changes to requirements for credentialing individual providers based on government and commercial payer credentialing processes
Proactively communicated any changes regarding contracting as it relates to enrollment and operations
Communicates updated payer enrollment information including payer provider numbers to practice operations in a timely manner while fostering working relationships and teamwork with departments, vendors, etc.
Develops databases and spreadsheets for tracking organization providers
Ensures data is accessible/transparent for executive inquiries or other information as deemed necessary by management

Requirements

What you’ll need

High School Diploma or GED
Required or PESC Certification
4-6 years Of experience in credentialing and enrollments with Payors, Medicare, Medicaid and Dental Payors Required or less than 1 year PESC Certification
Knowledge of federal and Colorado statutes, legislative initiatives and regulations, as well as federal, State and local policies
Knowledge of TJC, NCQA and/or CMS credentialing standards
Proficient in Microsoft Word, Excel, and Outlook
Ability to simultaneously coordinate and manage several functions, programs, and tasks in various stages of completion
Ability to interpret and apply policies and procedures
Skilled in providing excellent customer service
Ability to communicate in a professional and positive manner
Ability to consistently implement program, department and organizational policies and procedures
Must be able to work independently and meet schedules and deadlines. MD Staff provider enrollment knowledge is preferred

Benefits

Comp & perks

Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays
100% paid parental leave up to 6 weeks
Immediate eligibility for retirement plans with employer contribution up to 9.5%
Generous medical, dental, vision plans in addition to employer paid disability and life insurance
Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center
Free RTD EcoPass (public transportation)
Childcare discount programs & exclusive perks on large brands, travel, and more
Tuition reimbursement & assistance
Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways
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