Jefferson Health · 12 hours ago
Manager Provider Credentialing & Enrollment
Philadelphia, PA
Full-time
Onsite
Mid Level
3+ years expJefferson Health is a nationally ranked healthcare system dedicated to providing high-quality clinical care and education. The Manager of Provider Credentialing & Enrollment will oversee the operations of the Central Enrollments department and the physician credentialing function, ensuring compliance with health plans and managing the credentialing staff effectively.
Hospital & Health Care
Responsibilities
Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson
Manage staffing levels, workload allocation, and quality improvement initiatives for JMG Central Enrollments Department for both health plan enrollment as well as all Delegated Credentialing processes with designated health plans. Proactively manage all credentialing and enrollment processes and ensure that systems meet the needs of credentialing staff and that staff adhere to department standards regarding data integrity and confidentiality
Manage all communications of physician data to the various health plans regarding the structure and makeup of groups, practice names, tax identification numbers, NPIs, and practice site addresses for both JMG and MSO clients. Develop, implement and monitor departmental standards and procedures related to hard copy files, scanning, and linking documents, data entry, storage and retrieval for their JMG physician database
Primary liaison between Medical Staff Affairs Office (TJUH), JeffCARE (PHO), JMC Faculty Affairs, Jefferson Medical GroupAdministrative Office, and JMG Physician Business Services. This includes coordination and distribution of provider numbers and enrollment data from contracted health plans to internal departments and submission to the EPIC billing system
Review all delegated health plan contract language under negotiation regarding operational issues and compliance with all external (NCQA, Federal, HHS, DPW, and health plans) as well as all JMG internal policies and procedures. Develop and implement processes to incorporate all new delegated plans as they become contracted into current JMG processes including data exchanges, reporting, and identifying any necessary changes in the JMG physician Cactus database
Oversight of the Primary Source Verification process for credentialing providers. Ensure that credentialing staff meets strict timelines with an expected accuracy of documentation for presenting delegated credentialing file for approval at the monthly Credentialing SubCommittee meeting
Manage the enrollment and credentialing process of JMG physicians as well as Management Services Organization outside clients who pay for the services of JMG Central Enrollments. This includes oversight of credentialing staff for timely completion of various health plan applications, internal tracking of credentialing and enrollment process, ensure routine follow-up contact with health plans on mailed applications, and communication with Department Chairman, Administrators, and Key Contacts regarding the status of physicians in the process
Qualification
Required
Minimum 2 years supervisory experience, preferably in a position involving physician enrollment/credentialing and billing
Extensive experience and knowledge of managed care enrollment and contracting procedures and its impact to revenue cycle
Credentialing software experience. Understanding of NCQA guidelines for credentialing, primary source verification process, PA State, Medicare and Medicaid enrollment guidelines, physician sanctions review
Strong organizational skills. Ability to maintain confidential information
Ability to deal with multiple tasks and to be flexible regarding priorities and deadlines
Excellent interpersonal and communication skills, including group leadership abilities
High School Diploma, Associate or Bachelor Degree Preferred
Minimum (2) years of healthcare credentialing/billing experience required
Minimum 3 years customer service and managed care contract experience
Benefits
Medical (including prescription)
Supplemental insurance
Dental
Vision
Life and AD&D insurance
Short- and long-term disability
Flexible spending accounts
Retirement plans
Tuition assistance
Voluntary benefits
Tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service
Medical (including prescription) insurance
Company
Jefferson Health
Thomas Jefferson University and Thomas Jefferson University Hospitals are partners in providing excellent clinical and compassionate care for our patients in the Philadelphia region, educating the health professionals of tomorrow in a variety of disciplines and discovering new knowledge that will define the future of clinical care.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
ANTHONY S. NAH, Jr., B.S., MSc.
President / CEO
Ron Kumor
President/ CEO Aria Jefferson Health Physician Services and Senior Vice President, Network Dev
Recent News
Philadelphia Business Journal
2025-03-26
2024-04-29
Company data provided by crunchbase