Credentialing and Enrollment Coordinator (FT, Days)

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

Job summary

Join a forward-thinking healthcare organization where you will play a vital role in the credentialing and enrollment of medical professionals. This position involves working closely with physicians and payers to ensure a smooth enrollment process, maintaining accurate databases, and supporting the integrity of healthcare services. With a focus on detail and effective communication, you will thrive in a dynamic environment that values your contribution to the healthcare community. If you are passionate about improving healthcare access and have the skills to manage complex processes, this opportunity is perfect for you.

Qualifications

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

Responsibilities

• Credentialing and enrollment of Jefferson Medical Group physicians.
• Maintain the integrity of the credentialing and enrollment database.

Skills

Managed Care Experience

Credentialing Experience

Organizational Skills

Attention to Detail

Communication Skills

Multi-tasking

Education

High School Diploma

Associates Degree

Tools

Cactus

Microsoft Office

Job description

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

1. Interact with co-workers, visitors, and other staff consistent with the values of Jefferson.
2. Prepare initial and re-credentialing plan applications for non-delegated and auxiliary providers for Jefferson Medical Group (JMG) Physicians, as well as other physicians contracting with JMG.
3. Follow up and track provider applications submitted to payers. Connect with payers regarding application status and document/update the credentialing/enrollment database accordingly.
4. Process changes and terminations from departments and practices in a timely manner.
5. Investigate provider claim holds and submit requests to release holds once payer setup confirmation is received.
6. Assist the Delegated Credentialing team with Primary Source Verification for submission to the Jeffcare Committee for approval.
7. Update and maintain the integrity of the credentialing and enrollment database, ensuring accurate physician and practice information in JMG and external credentialing databases.

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

1. High School Diploma required; Associates Degree or higher preferred.
2. Minimum one year experience working in a managed care setting required.
3. Understanding of NCQA standards and Managed Care Plans required.
4. Prior credentialing/enrollment experience preferred.
5. Experience in obtaining primary source verification of credentials preferred.
6. Working knowledge of credentialing/enrollment systems (e.g., Cactus). Certified Provider Credentialing Specialist (CPCS) preferred.

Required Knowledge, Skills, and Abilities

Knowledge of payer contracting and enrollment criteria for health plans. Experience with CMS/PECOS provider enrollment. Ability to multi-task, strong organizational skills, attention to detail, and ability to work in a fast-paced environment. Effective interaction with physicians and medical staff offices. Strong written and verbal communication skills. Proficiency in Microsoft Office.

Work Shift

Day shift (United States of America)

Worker Sub Type

Regular

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America