Supports the credentialing and enrollment process that directly impacts the ability of Jefferson University Physicians (JUP) as well as other physicians that contract with JUP Central Enrollments (JCE) to bill for services rendered by health care providers thereby directly impacting JUP revenue generation. Process the non-delegated and auxiliary enrollment applications for the various Managed Care plans.

Provider Enrollment

• Prepare initial and recredentialing plan applications for non-delegated and auxiliary providers for Jefferson University Physicians (JUP) as well as other physicians that contract with JUP Central Enrollments (JCE).
• Follow up and track provider applications mailed to payors. This includes calling payors regarding the status of mailed applications as well as keeping notes in the database on the application progress until provider number is obtained.
• Process change requests from departments and practices in a timely fashion.
• Maintain and understand Managed Care Plan policies and procedures as well as NCQA standards with regards to physician credentialing and enrollment.
• Works with health plan contacts to update/change provider information and to resolve issues.

Data Management

• Maintain integrity of physician and practice information in JUP physician database and outside credentialing databases (NPPES & CAQH).
• Maintain proficiency in utilizing JUP physician database.
• Maintain data for weekly status report distribution.
• Enter comments and/or provider numbers into JUP database in a timely and accurate manner.
• Compile, review, scan and link all confidential documents to physician access databases.
• Review and work IDX Provider Edit reports to resolve issues and maintain edits at low levels.
• Enter provider numbers into JUP database in a timely and accurate manner.
• Issue external aging report for all assigned plans.
• Responsible for running various queries / reports from physician database.

Position Specific:

• Monday - Friday 8:30am-5:00pm

• Center City

EDUCATIONAL/TRAINING REQUIREMENTS:

• Finance or business related area or equivalent work experience.
• High School degree or GED equivalent is required.
• NAM Certification is preferred

EXPERIENCE REQUIREMENTS:

• Minimum of one year experience working in a managed care setting
• Experience in credentialing and/or enrollment, with familiarity of NCQA Guidelines
• Experience in obtaining Primary Source Verification of credentials
• Cactus Software experience is preferred
• Strong organizational skills with a high attention to detail
• Ability to maintain confidential information
• Ability to handle multiple tasks and to be flexible regarding priorities and deadlines
• Excellent interpersonal and communication skills.
• Working knowledge of Microsoft Office products as well as Adobe Acrobat (.pdf files)

Covid Vaccination is a requirement for employment at Jefferson for employees working at Jefferson’s clinical entities or at the University. If you are not currently vaccinated you will be required to receive the vaccination prior to hire date if you are offered employment, unless you request and receive an approved medical or religious exemption from Jefferson.

Jefferson Health delivers state of the art healthcare services to patients throughout the Delaware Valley and southern New Jersey. Jefferson (Philadelphia University + Thomas Jefferson University) provides more than 8,400 students from nearly 40 states and 40 countries with 21st century professional education. Combined, we have over 30,000 employees.

Jefferson Health, with 14 hospitals (seven are Magnet designated by the ANCC for nursing excellence) and 40+ outpatient and urgent care locations, offers a broad range of primary and complex, highly specialized care that touches the lives of more than four million patients annually. U.S. News & World Report has ranked Thomas Jefferson University Hospital among the nation’s best in eight specialties. Jefferson Health also includes the NCI designated Sidney Kimmel Cancer Center; it is one of only 70 such centers in the nation.

Thomas Jefferson University has ten colleges and three schools that offer more than 160 undergraduate and graduate programs. Our University is dedicated to inter-professional and transdisciplinary approaches to learning that offer a vibrant and expandable platform for professional education. Through this unique model, we are preparing our students for current and yet to be imagined careers.

As an employer, Jefferson maintains a commitment to provide equal access to employment. Jefferson values diversity and encourages applications from women, members of minority groups, LGBTQ individuals, disabled individuals, and veterans.