Role Description
Responsible for credentialing JMG (Jefferson Medical Group) and JeffCare PHO physicians according to National Committee for Quality Assurance (NCQA). Works with Jefferson Medical Staff to ensure credentialing documentation is shared and coordinated as part of the JeffCare Credentialing Process.
• Perform primary source verification for each provider for initial and reappointments, in accordance with contractual requirements with delegated health plans, JeffCare's Delegated Credentialing Policies and procedures, NCQA, and Department of Public Welfare.
• Prepare individual physician credentialing files in accordance with all established standards.
• Update and maintain demographic and credentialing information in the database.
• Maintain the integrity of the Delegation Agreement.
• Work with Quality Assurance Representatives of health plans regarding JMG's and JeffCare PHO's Enterprise credentialing policies and procedures for delegation.
• Prepare physician welcome letters, expirables, create/run reports and queries as required.
• Manage and Present at the JeffCare Credentialing meetings (agenda, recordings, minutes, etc.) identifying any issues, concerns, and recommendations.
Qualifications
• High School Diploma/GED (Required)
• Associate’s Degree or Bachelor’s Degree in healthcare administration (Preferred)
Requirements
• 2 years experience in credentialing/enrollment with delegated credentialing experience strongly preferred.
• Proficiency with Microsoft Office and Credentialing software.
• Critical thinking skills, able to organize and prioritize work strategically.
• Detail oriented.
• Ability to multi-task and meet deadlines.
• Problem solving skills, ability to identify options and effective solutions to delegated credentialing questions or issues.
• Ability to communicate appropriately, professionally, and effectively with associates, partners, and leadership.
• Strong oral and written communication skills.
Benefits
• 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, and tuition assistance.
• Access to voluntary benefits, which provide colleagues with access to group rates on insurance and discounts.
• Tuition discounts at Thomas Jefferson University after one year of full-time service or two years of part-time service.
• Access to medical (including prescription) insurance for all colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps).
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