Healthcare Operations Manager

3 weeks ago


Philadelphia, Pennsylvania, United States Jefferson Health Full time
Job Summary

We are seeking a highly skilled and experienced Healthcare Operations Manager to join our team at Jefferson Health. As a key member of our operations team, you will be responsible for managing the day-to-day activities of our Central Enrollments department, including health plan enrollment and physician credentialing.

Key Responsibilities
  • Manage Health Plan Enrollment and Credentialing Processes: Oversee the enrollment and credentialing process for JMG physicians and Management Services Organization outside clients, ensuring timely completion of health plan applications and routine follow-up contact with health plans.
  • Lead Credentialing Staff: Supervise and mentor credentialing staff to ensure they meet strict timelines and maintain high accuracy in documentation for delegated credentialing files.
  • Develop and Implement Processes: Create and implement processes to incorporate new delegated plans into current JMG processes, including data exchanges, reporting, and identifying necessary changes in the JMG physician database.
  • Primary Liaison: Serve as the primary liaison between Medical Staff Affairs Office, JeffCARE, JMC Faculty Affairs, Jefferson Medical Group Administrative Office, and JMG Physician Business Services.
  • Review Contract Language: Review delegated health plan contract language under negotiation regarding operational issues and compliance with external and internal policies and procedures.
Requirements
  • Education: High School Diploma, Associate or Bachelor Degree Preferred
  • Experience: Minimum 2 years of healthcare credentialing/billing experience required, with a minimum of 3 years customer service and managed care contract experience
  • Certifications: Certified Provider Credentialing Specialist (CPCS)
  • Skills: Strong organizational skills, ability to maintain confidential information, and excellent interpersonal and communication skills
About Jefferson Health

Jefferson Health is a nationally ranked, not-for-profit health care system that is reimagining health care and higher education to create unparalleled value. We are committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.



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