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

Credentialing Specialist

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 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 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, expirables, create/run reports and queries as required.
• Manage and present at the JeffCare Credentialing meetings (agenda, 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.