Credentialing Specialist

Thomas Jefferson University & Jefferson Health; Philadelphia (Philadelphia County); On-site; USD 55,000 - 70,000; Full time

Benefits offered by this job

Medical insurance

Tuition assistance

Retirement plans

Job summary

Thomas Jefferson University Hospitals, Inc. is seeking a Credentialing Specialist to verify qualifications, manage initial appointments, and support privilege delineation for medical staff and allied health professionals.

This role requires meticulous data management, reporting on application status, and collaboration with clinical departments and external parties to ensure regulatory compliance and timely credentialing decisions.

Qualifications

• Bachelor’s degree in business, healthcare administration, human resource management, or related field.
• 2 years credentialing experience preferred but not required.
• CPCS or CPMSM preferred but not required.
• Knowledge of credentialing management software preferred but not required.
• Microsoft Office proficiency required.

Responsibilities

• Verifications for medical staff and allied health professionals' initial appointments, re-appointments, and privilege delineation.
• Maintains credentialing database for completeness and accuracy.
• Runs reports on provider data accuracy and application status.
• Provides ad hoc support to assist credentialing committee with approvals, grants, and release of privileges.
• Participates in process improvement initiatives to enhance credentialing procedures and outcomes.
• Communicates with internal and external customers to obtain or provide necessary information related to verifications and malpractice claims.
• Assists in compliance with accrediting bodies (e.g., The Joint Commission) regarding credentialing.
• Acts as a liaison between hospital clinical departments, practitioner applicants, and external parties.

Skills

Attention to detail

Forward-thinking

Critical thinking

Process improvement

Education

Bachelor’s degree in business, healthcare administration, HR, or related field

Tools

Credentialing software

Microsoft Office

Job description

Number of Positions In Requisition

1

Job Details

.

Job Description

ESSENTIAL FUNCTIONS:

• Responsible for verifications for medical staff and/or allied health professionals' initial appointments, re-appointments, and privilege delineation.
• Maintains credentialing database by ensuring that information entered is both complete and accurate.
• Runs various reports regarding:
  • Accuracy of provider data
  • Application status.
• Provides ad hoc support to assist with the credentialing committee’s approval, granting, and ultimately, release of privileges.
• Demonstrates willingness to be an active participant in process improvement initiatives and special projects to enhance credentialing procedures and outcomes.
• Communicate with internal and external customers to obtain or provide necessary information as it relates to verifications, malpractice claims, and any other pertinent information.
• Assists in compliance with accrediting and regulatory agencies (i.e., The Joint Commission) regarding credentialing by maintaining a working knowledge of statutes and laws.
• Acts as a liaison between hospital clinical departments, practitioner applicants, and other external parties.

ADDITIONAL QUALIFICATIONS:

• Demonstrates attention to detail in all aspects of work.
• Forward-thinking mindset to anticipate and address potential challenges or opportunities.
• Strong ability to think critically and problem-solve effectively.
• Willingness to be an active participant in process improvement initiatives and special projects to enhance credentialing procedures and outcomes.

JOB REQUIREMENTS:

• Bachelor’s degree in business, healthcare administration, human resource management, or another related field required.
• 2 years of prior credentialing experience preferred but not required.
• Certified Provider Credentialing Specialist (CPCS), or Certified Professional Medical Services Management (CPMSM) is preferred but not required.
• Knowledge of credentialing management software is preferred but not required.
• Knowledge of Microsoft Office required.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Thomas Jefferson University Hospitals, Inc.

Primary Location Address

111 S 11th Street, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

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.

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.