Credentialing and Enrollment Coordinator (FT, Days)

About the role

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.

Responsibilities

• Prepare initial and recredentialing plan applications for non-delegated and auxiliary providers for the Jefferson Medical Group (JMG) Physicians, as well as other physicians that contract with JMG.
• Follow up and track provider applications submitted to payers.
• Connect with 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 integrity of physician and practice information in JMG physician enrollment database and outside credentialing databases.

Requirements

• HS Diploma required; Associates Degree or higher preferred.
• Minimum one year experience working in a managed care setting required.
• Understanding of National Committee for Quality Assurance (NCQA) and Managed Care Plans required.
• Prior credentialing/enrollment experience preferred.
• Experience in obtaining primary source verification of credentials preferred.
• Working knowledge of credentialing/enrollment systems (i.e., Cactus).
• Certified Provider Credentialing Specialist (CPCS) preferred.

Required Knowledge, Skills, and Abilities

• 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 a high-pace 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.