Provider Delegated Credentialing Analyst

Job Details

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.

Job Description

Summary
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.

Job Duties

• Perform primary source verification for each provider for initial and reappointments, in accordance with contractual requriements with delegated health plans, JeffCare's Delegated Credentialing Policies and procedures, NCQA and Department of Public Welfare.
• Prepare individual physcian credentialing files in accordance with all established standards. Update and maintain demograhic and credentialing information in database.
• Maintain the integreity 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 physcian welcome letters, expirables, create/run reports and queries as required.
• Manage and Present at the JeffCare Credentialing meetings (agena, recordings, minutes, etc..) identifying any issues, concerns and recommendations.

Minimum Qualifications

• High School Diploma/GED
• 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-tasks 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

Preferred Qualifications

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

Additional Qualifications

Physical Demands
Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Thomas Jefferson University

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.    

Jefferson is 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. 

Benefits

Jefferson offers a 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, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. 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.

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