Provider Enrollment Coordinator

Jefferson Health Plans • Philadelphia, PA

3d

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 ensure required documentation is obtained and complete for a smooth enrollment process. Job Description Essential Functions Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson. Prepare initial and recredentialing plan applications for non-delegated providers. Follow up and Track applications submitted to payers using credentialing software. Connect with payers regarding status of applications, correcting issues and resubmitting timely as needed Process changes and terminations of providers timely Investigate provider claim holds and release claims once confirmation of payer setup is complete. Maintain the integrity of physician and practice information as well as outside databases (CAQH, Availity, etc.) Completion of other projects as assigned to support the department.

Requirements

• Knowledge of criteria for health plans payer enrollment.
• Experience with CMS/PECOS provider enrollment.
• Ability to multi-task.
• Strong organizational skills with keen attention to detail.
• Ability to work in a fast paced 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.
• High School Diploma
• Experience with Microsoft Office Suite-Teams, Word, Excel, Outlook-intermediate user.
• Comfortable with heavy workload and multiple conflicting priorities.
• Organized and detail-oriented.

Nice To Haves

• Preferred experience working in a managed care or medical setting.
• RCM experience a plus.

Responsibilities

• Prepare initial and recredentialing plan applications for non-delegated providers.
• Follow up and Track applications submitted to payers using credentialing software.
• Connect with payers regarding status of applications, correcting issues and resubmitting timely as needed
• Process changes and terminations of providers timely
• Investigate provider claim holds and release claims once confirmation of payer setup is complete.
• Maintain the integrity of physician and practice information as well as outside databases (CAQH, Availity, etc.)
• Completion of other projects as assigned to support the department.

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: Entry Level
• Education Level: High school or GED
• Number of Employees: 501-1,000 employees