Credentialing and Enrollment Coordinator (FT, Days)

Jefferson Health; Philadelphia (Philadelphia County); On-site; USD 40,000 - 70,000; Full time

Job summary

An established industry player is seeking a Credentialing and Enrollment Coordinator to enhance their enrollment processes. This pivotal role involves ensuring that physicians are properly credentialed with commercial and government payers, while maintaining accurate databases. The ideal candidate will thrive in a fast-paced environment, demonstrating strong organizational skills and effective communication. Join a team dedicated to supporting healthcare professionals and ensuring seamless operations within a respected organization. This is a fantastic opportunity to contribute to the healthcare landscape while advancing your career in a supportive setting.

Qualifications

• 1+ years of experience in a managed care setting.
• Understanding of NCQA and Managed Care Plans required.

Responsibilities

• Responsible for credentialing and enrollment of physicians.
• Track provider applications and communicate with payers.

Skills

Organizational Skills

Attention to Detail

Multitasking Ability

Effective Communication Skills

PC Proficiency (Microsoft Office)

Education

High School Diploma

Associate's Degree

Tools

Credentialing Systems (e.g., Cactus)

Job description

Credentialing and Enrollment Coordinator (FT, Days)

Join to apply for the Credentialing and Enrollment Coordinator (FT, Days) role at Jefferson Health.

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 ensure required documentation is obtained and complete for a smooth enrollment process.

Job Description

• Interact with co-workers, visitors, and staff consistent with Jefferson's values.
• Prepare initial and recredentialing plan applications for non-delegated and auxiliary providers for JMG Physicians and other contracted physicians.
• Follow up and track provider applications submitted to payers; communicate with payers regarding application status; update credentialing/enrollment databases.
• Process changes and terminations from departments and practices promptly.
• Investigate provider claim holds and submit requests to release holds once payer setup is confirmed.
• Assist the Delegated Credentialing team with Primary Source Verification for Jeffcare Committee approval.
• Maintain the integrity of physician and practice information in credentialing databases.

Minimum Requirements

• HS Diploma required; Associate's Degree or higher preferred.
• At least one year of experience in a managed care setting.
• Understanding of NCQA and Managed Care Plans required.
• Credentialing/enrollment experience and primary source verification experience preferred.
• Knowledge of credentialing systems (e.g., Cactus); CPCS certification preferred.

Skills and Abilities

• Knowledge of payer contracting and enrollment criteria, including CMS/PECOS.
• Strong organizational skills, attention to detail, multitasking ability.
• Ability to work in a high-paced environment and meet deadlines.
• Effective communication skills, PC proficiency with Microsoft Office.

Work Details

• Shift: Day shift (United States)
• Type: Full-time, Regular

Location

1101 Market, Philadelphia, PA