Credentialing and Enrollment Coordinator (FT, Days)

Thomas Jefferson University; Jefferson Center (PA); On-site; USD 40,000 - 70,000; Full time

Job summary

Join a forward-thinking organization as a Credentialing and Enrollment Coordinator. In this vital role, you will manage the credentialing and enrollment processes for a group of dedicated physicians, ensuring they meet all necessary requirements for successful integration with commercial and government payers. Your attention to detail and strong organizational skills will be key as you handle applications, track statuses, and maintain critical databases. This position offers an opportunity to work in a dynamic environment where your contributions will directly impact the efficiency of healthcare services. If you're ready to make a difference in a fast-paced setting, this is the perfect opportunity for you.

Qualifications

• Minimum one year experience in a managed care setting required.
• Understanding of NCQA and Managed Care Plans required.

Responsibilities

• Responsible for credentialing and enrollment of physicians with payers.
• Update and maintain the integrity of credentialing databases.

Skills

Organizational Skills

Communication Skills

Attention to Detail

Multi-tasking

Education

High School Diploma

Associate's Degree

Tools

Cactus

Microsoft Office

Job description

Credentialing and Enrollment Coordinator (FT, Days)

Apply locations Philadelphia, PA time type Full time posted on Posted 5 Days Ago job requisition id REQ-0003820

Job Details

Responsible for the credentialing and enrollment of Jefferson Medical Group (JMG) physicians with contracted commercial and government payers. Works with assigned department staff to ensuring required documentation is obtained and complete for a smooth enrollment process.

Job Description

• Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.

• Prepare initial and recredentialing plan applications for non-delegated and auxiliary providers for the Jefferson Medical Group (JMG) Physicians, as well as other physicians that contract with JMG.

• Follow up and track provider applications submitted to payers. Connect payers regarding status of applications and document/update the credentialing/enrollment database with status.

• Process changes and terminations from departments and practices timely.

• Investigate provider claim holds, and submit request to release hold once confirmation of payer set up is received.

• Assist the Delegated Credentialing team with Primary Source Verification for submission to the Jeffcare Committee meeting for approval.

• Update credentialing and enrollment database. Maintain the integrity of physician and practice information in JMG physician enrollment database and outside credentialing databases.

Required Experience, Education, Certification(s), License(s)

• HS Diploma required, Associates Degree or higher preferred.

• Minimum one year experience working in a managed care setting required.

• Understanding of National Committee for Quality Assurance (NCQA) and Managed Care Plans required.

• Prior credentialing / enrollment experience preferred.

• Experience in obtaining primary source verification of credentials preferred.

• Working knowledge of credentialing/enrollment systems (i.e. Cactus) Certified Provider Credentialing Specialist (CPCS) preferred.

Required Knowledge, Skills, and Abilities (Proficiencies):

Knowledge of payer contracting and criteria for health plans payer enrollment. Experience with CMS/PECOS provider enrollment. Ability to multi-task. Strong organizational skills with a keen attention to detail. Ability to work in high pace and high profile environment meeting tight deadlines. Ability to interact effectively with a variety of people (such as physicians and medical staff offices). Strong written and verbal communication skills. Excellent PC skills with experience using Microsoft Office Package.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.