Credentialing Manager - 10488

The mission of the Colorado Coalition for the Homeless is to work collaboratively toward the prevention of homelessness and the creation of lasting solutions for homeless and at-risk families, children, and individuals throughout Colorado. The Coalition advocates for and provides a continuum of housing and a variety of services to improve the health, well-being, and stability of those it serves.

Our Philosophy of Service: We believe all people have the right to adequate housing and health care. We work to remove the barriers that restrict access to these rights. Society benefits when adequate housing and health care are available to everyone. We create lasting solutions to homelessness by:

* Honoring the inherent dignity of those we serve, affirming their capabilities and fostering their hope that a better life is possible.

* Building strong, caring and trauma-informed communities through the integration of housing, health care and supportive services.

* Advocating for social and racial equity, inclusion and diversity, and challenging the status quo in partnership with our workforce members and those we serve.

* Achieving excellence through continuous quality assurance, innovation and professional development.

* Using resources judiciously and effectively.

The Credentialing Manager oversees and manages the overall operations and processes for credentialing services to develop, evaluate, and monitor procedures that support the initial credentialing, recredentialing, and re-privileging of staff, volunteers, and non-licensed providers. Organizes and reports site and provider enrollments and revalidations with Medicare, Medicaid, and other payer plans. Coordinates the staff and volunteer provider data reporting for the annual FTCA malpractice grant application. Facilitates the filing of the annual Medicare and Medicaid cost reports and audits. Communicates and interacts professionally with internal and external management, healthcare plans, and regulatory representatives. Standard of compliance with regulatory requirements, reporting, and maintaining people metrics that support business decision

Coalition Benefits

• Choice of HMO or PPO health insurance coverage options: full-time employees contribute only 1% of their earnings for their own HMO health coverage and no more than 4% of their earnings for coverage of eligible dependents. We're proud to offer same-and opposite-sex domestic partner coverage.
• Choice of dental insurance or discount plan.
• Vision insurance.
• Flexible spending accounts for health care / dependent care / parking expenses.
• Free basic life and AD&D insurance coverage.
• Employee Assistance Program, a problem-solving resource available to you and your household members.
• Dollar-for-dollar retirement plan matching contributions up to 5% of earnings with 3-year vesting.
• Extensive paid time-off, including 9 holidays, 12 days of sick leave, and three weeks of vacation for new full-time employees in their first year.
The effective date for your benefits will be the first of the month following your date of hire.

Essential Job Functions

• Evaluate and support an efficient credentialing and privileging process.
• Manages staff with the day-to-day processes of credentialing, re-credentialing, and privileging applications of staff, volunteers, and non-licensed providers.
• Implement policies and procedures to ensure that applications and enrollments are correctly verified and accurately filed, and import and export provider data into the credentialing database systems (CACTUS and CAQH).
• Administers a comprehensive review of the Council for Affordable Quality Healthcare (CAQH) profile for all practitioners, ensuring completeness and accuracy of the information.
• Organizes and manages the credentialing and privileging committee meetings, agendas, minutes, and all CCH board privileging requirements, including sending the privileging letters to providers after Board approval.
• Prepares and analyzes reports on trends in provider application and enrollment status. Create and maintain credentialing policies, procedures, and workflows to ensure continued compliance with all regulatory and contractual credentialing requirements.
• Review all data elements collected from providers during the initial onboarding, recredentialing, and re-privileging process.
• Coordinates and files the provider enrollments in Medicare, Medicaid, and other healthcare plans.
• Provides regular status reports and timely appropriate escalation of provider and insurance enrollment participation issues to Revenue Cycle.
• Interacts and communicates provider information to other support departments such as HR, Revenue Cycle, Accounting, Resource Development, and Data.
• Prepares and files CCH's site enrollments, updates, and revalidations through the PECOS and Health First (CO Medicaid) portal programs. (855 application filing) Education
• Initiates and files provider linking/affiliations to each CCH practice location to healthcare plans/contracts.
• Assists with preparing various reports, collecting provider data as requested, preparing correspondence and reports, and compiling documents for new and renewed contract filings.
• Responsible for preparing and coordinating the HRSA OSV of Clinical Staffing, e.g., credentialing and privileging for CCH.
• Coordinates and files the yearly FTCA malpractice insurance grant application for CCH staff and volunteer providers.
• Responsible for the analysis and collection of required data elements used in preparing and filing the Medicare and Medicaid cost reports.
• Manage the cost report process from work-paper set preparation to cost report filing, including engaging various department personnel to ensure meeting necessary deadlines.
• Manage all aspects of Medicare or Medicaid audit support and adjustment reviews, including supporting documentation provided to the CFO, CEO, Board, and auditors, filing Medicare and Medicaid cost report appeals, and completing position papers.
• Prepare and manage Medicare and Medicaid reimbursement projects with senior management, including regulatory research and financial analysis or proformas.
• Performs other duties as assigned.

Qualifications Summary

• Bachelor's degree/associate's degree in healthcare administration, business, or a similar field.
• Certified Professional Medical Services Management, or other related certifications
• Managing and reporting experience in compliance, regulatory reporting, audits and surveys, government reimbursements, and healthcare contracting.
• Medicare and Medicaid cost report preparation, filing, auditing, and appeals within hospital systems, nursing homes, psych, rehabs, clinics, health centers, home health, rural health, respite, and hospice. Certification in the field is preferred but not required.
• Credentialing process and source verification
• Privileging experience/knowledge
• Accreditation standards
• Management and leadership experience

$70,238 - $84,286 an hour

The Colorado Coalition for the Homeless is committed to delivering services, making employment-related decisions, selecting volunteers, and selecting vendors without regard to age over 40, race, sex, color, religion, creed, national origin, ancestry, disability, genetic information, marital status, sexual orientation, gender identity, gender expression, pregnancy, medical condition related to pregnancy, military status, or any other applicable status protected by law.