Credentialing and Enrollment Coordinator (FT, Days)

Thomas Jefferson University•Philadelphia, PA

7d•Onsite

About The Position

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. Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson. 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.

Requirements

HS Diploma required
Minimum one year experience working in a managed care setting required.
Understanding of National Committee for Quality Assurance (NCQA) and Managed Care Plans required.
Knowledge of payer contracting and criteria for health plans payer enrollment.
Experience with CMS/PECOS provider enrollment.
Ability to multi-task.
Strong organizational skills with a keen attention to detail.
Ability to work in high pace and high profile environment meeting tight deadlines.
Ability to interact effectively with a variety of people (such as physicians and medical staff offices).
Strong written and verbal communication skills.
Excellent PC skills with experience using Microsoft Office Package

Nice To Haves

Associates Degree or higher preferred.
Prior credentialing / enrollment experience preferred.
Experience in obtaining primary source verification of credentials preferred.
Working knowledge of credentialing/enrollment systems (i.e. Cactus).
Certified Provider Credentialing Specialist (CPCS) preferred.

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.

Benefits

medical (including prescription)
supplemental insurance
dental
vision
life and AD&D insurance
short- and long-term disability
flexible spending accounts
retirement plans
tuition assistance
voluntary benefits
tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service.