Provider Credentialing and Enrollment Coordinator

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

Job summary

An established industry player is seeking a Provider Credentialing and Enrollment Coordinator to facilitate the credentialing process for medical professionals. In this pivotal role, you will ensure the smooth enrollment of physicians with various payers, maintain critical databases, and uphold the integrity of provider information. If you have a passion for healthcare and experience in managed care settings, this role offers a fantastic opportunity to make a significant impact while working in a collaborative environment. Join a team that values equal opportunity and is dedicated to excellence in healthcare services.

Qualifications

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

Responsibilities

• Credentialing and enrollment of physicians with payers.
• Maintain integrity of physician information in databases.

Skills

Credentialing experience

Managed care knowledge

Primary source verification

Communication skills

Education

High School Diploma

Associate's Degree

Tools

Cactus

Job description

Provider Credentialing and Enrollment Coordinator page is loaded

Provider Credentialing and Enrollment Coordinator

Apply locations Philadelphia, PA time type Full time posted on Posted 5 Days Ago job requisition id REQ-0004550

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

Responsibilities:

• 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:

• HS Diploma required.
• Minimum one year experience working in a managed care setting.
• Understanding of National Committee for Quality Assurance (NCQA) and Managed Care Plans.
• Associates Degree or higher preferred.
• Prior credentialing/enrollment experience.
• Experience in obtaining primary source verification of credentials.
• Working knowledge of credentialing/enrollment systems (i.e. Cactus).
• Certified Provider Credentialing Specialist (CPCS).

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.