Provider Delegated Credentialing Analyst (Full-Time/Day) Center City

About the Role

Responsible for credentialing JMG (Jefferson Medical Group) and JeffCare PHO physicians according to National Committee for Quality Assurance (NCQA) standards. Works with Jefferson Medical Staff to ensure credentialing documentation is shared and coordinated as part of the JeffCare Credentialing Process.

Responsibilities

• 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, track expiring credentials, create and run reports and queries as required.
• Manage and present at the JeffCare Credentialing meetings (agenda, recordings, minutes, etc.), identifying any issues, concerns, and recommendations.

Requirements

• High School Diploma/GED.
• 2 years of experience in credentialing/enrollment; delegated credentialing experience strongly preferred.
• Proficiency with Microsoft Office and Credentialing software.
• Critical thinking skills, ability to organize and prioritize work strategically.
• Detail-oriented with strong problem-solving skills to identify options and effective solutions for delegated credentialing questions or issues.
• Ability to communicate appropriately, professionally, and effectively with associates, partners, and leadership.
• Strong oral and written communication skills.

Preferred Qualifications

• Associate’s Degree or Bachelor’s Degree in healthcare administration.

Physical Demands

• Lift and carry up to 25 lbs.
• Frequent sitting/standing and keyboard use.

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including:

• Medical (including prescription), supplemental insurance, dental, and vision coverage.
• Life and AD&D insurance, short- and long-term disability.
• Flexible spending accounts and retirement plans.
• Tuition assistance and access to tuition discounts at Thomas Jefferson University after one year of full-time service or two years of part-time service.
• Voluntary benefits, providing access to group rates on insurance and discounts.

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.

Schedule

Workday Day (United States of America)

Location

1101 Market, Philadelphia, Pennsylvania, United States of America