Provider Credentialing

2 weeks ago

Philadelphia, United States Jefferson Health Full time
Job Summary:

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 documentaiton is obtained and complete for a smooth enrollment process.

Responsibilities:
  • Prepare initial and recredentialing plan applications for non-delegated and auxiliary providers for the Jefferson Medial 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 integreity of physician and practice information in JMG physician enrollment database and outside credentialing databases.
Qualifications
  • HS Diploma required.Associates Degree or higher preferred.
  • Minimum one year experience working in a managed care setting
  • Prior credentialing / enrollment experience.
  • Experience in obtaining primary soruce verification of credentials.
  • Working knowledge of credentialing/enrollment systems (i.e. Cactus) Certified Provider Credentialing Specialist (CPCS)
  • Understanding of National Committee for Quality Assurance (NCQA) and Managed Care Plans.
  • 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 enrvironment 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


Par Reference Code

104834

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