Physician Credentialing & Enrollment Specialist

Jefferson Health; Philadelphia (Philadelphia County); Hybrid; USD 60,000 - 90,000; Full time

Job summary

Jefferson Health is seeking a Credentialing & Enrollment Specialist to manage credentialing and enrollment of Jefferson Medical Group physicians with commercial and government payers. You will ensure documentation is complete and accurate for timely submissions.

The role supports the Delegated Credentialing team, performs primary source verification, maintains databases, tracks applications, and communicates with payers to resolve holds and status updates in a fast-paced environment.

Qualifications

• HS Diploma required; associates degree or higher preferred.
• Minimum one year in a managed care setting.
• Understanding of NCQA and managed care plans.
• Credentialing/enrollment experience preferred.
• Experience with primary source verification of credentials.

Responsibilities

• Credentialing and enrollment of JMG physicians with commercial and government payers.
• Ensure required documentation is obtained and complete for enrollments.
• Prepare initial and recredentialing plans for providers.
• Follow up and track applications with payers.
• Update credentialing/enrollment database and verify status.

Skills

Credentialing

Enrollment

Payer contracting

CMS/PECOS

Multi-tasking

Communication skills

Microsoft Office

Education

HS Diploma

Associate degree or higher

Tools

Cactus

Job description

Jefferson Health is seeking a Credentialing & Enrollment Specialist to manage credentialing and enrollment of Jefferson Medical Group physicians with commercial and government payers. You will ensure documentation is complete and accurate for timely submissions.

The role supports the Delegated Credentialing team, performs primary source verification, maintains databases, tracks applications, and communicates with payers to resolve holds and status updates in a fast-paced environment.