Credentialing Specialist - Full Time

Jefferson Health Plans • Philadelphia, PA

3d • Onsite

About The Position

The Credentialing Specialist is responsible for verifying information for medical staff and allied health professionals during initial appointments and reappointments, as well as supporting privilege delineation. The role maintains accurate and complete credentialing database records and generates reports on provider data accuracy and application status.

The specialist provides ad hoc support for credentialing committee approvals, granting and release of privileges; communicates with internal and external customers to obtain or share information about verifications, malpractice claims and other pertinent matters; and serves as a liaison among hospital clinical departments, practitioner applicants and external parties. The role also supports compliance with accrediting and regulatory agencies, including The Joint Commission, by maintaining working knowledge of applicable statutes and laws. Participation in process improvement initiatives and special projects is expected.

Requirements

• Bachelor’s degree in business, healthcare administration, human resource management or another related field.
• Knowledge of Microsoft Office.
• Demonstrated attention to detail.
• Forward-thinking mindset to anticipate and address potential challenges or opportunities.
• Strong critical-thinking and problem-solving ability.

Nice To Haves

• Two years of prior credentialing experience.
• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification.
• Knowledge of credentialing management software.

Responsibilities

• Verify information for medical staff and allied health professionals' initial appointments, reappointments and privilege delineation.
• Maintain the credentialing database, ensuring that entered information is complete and accurate.
• Run reports on provider data accuracy and application status.
• Provide ad hoc support for credentialing committee approval, granting and release of privileges.
• Participate in process improvement initiatives and special projects to enhance credentialing procedures and outcomes.
• Communicate with internal and external customers to obtain or provide information related to verifications, malpractice claims and other pertinent matters.
• Assist with compliance with accrediting and regulatory agencies, including The Joint Commission, by maintaining working knowledge of statutes and laws.
• Act as a liaison between hospital clinical departments, practitioner applicants and external parties.

Benefits

• Medical insurance, including prescription coverage.
• Supplemental insurance.
• Dental insurance.
• Vision insurance.
• Life and AD&D insurance.
• Short- and long-term disability coverage.
• Flexible spending accounts.
• Retirement plans.
• Tuition assistance.
• Voluntary benefits, including access to group insurance rates and discounts.
• Tuition discounts at Thomas Jefferson University after one year of full-time service or two years of part-time service.
• Medical insurance, including prescription coverage, is available to all colleagues, including those working less than part-time.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level