Credentialing System Data Manager (Full-Time/Day)

Jefferson Health Plans • Philadelphia, PA

11d

About The Position

Responsible for the comprehensive management and integrity of the organization's provider credentialing data and systems. This role ensures strict compliance with regulatory standards, including NCQA requirements, by maintaining accurate provider information, preparing essential reports and delegated payer rosters, and coordinating all internal and external payer audits. Key responsibilities also include managing system upgrades and testing, responding to payer inquiries, developing custom report queries for leadership, and ensuring the confidentiality and integrity of all credentialing information.

Requirements

• Minimum Bachelor’s degree preferred AND/OR
• Proven experience developing and documenting technical business requirements for system enhancements or reports inclusive of data management
• 3-5 years of experience in a healthcare setting, ideally within credentialing, provider data management, or a related compliance/auditing role.
• Knowledge of NCQA requirements.

Responsibilities

• Manage and maintain the integrity of all system elements and data within the credentialing software (ECHO and CACTUS).
• Make recommendations for improving reporting and processes.
• Distribute reports related to upcoming expirables and ensure the system is accurately updated and maintained.
• Design, create, and execute custom data queries for both the ECHO and CACTUS credentialing systems to support internal reporting needs, leadership inquiries, and staff requests.
• Generate and manage routine and custom reports, specifically for payer rosters.
• Ensure that all departmental policies and procedures strictly adhere to current National Committee for Quality Assurance (NCQA) standards and other applicable regulatory requirements.
• Manage and coordinate the processes and workflows of data coordinators when applicable, ensuring efficient and accurate data handling practices.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 501-1,000 employees