Credentialing Specialist

Job Details

Job Description

• Responsible for obtaining and maintaining critical provider credentialing data for initial credentialing and re-credentialing. Creates and carries out various credentialing processes in relation to physicians and various other healthcare professionals. Assists JMG Operations with Enterprise Pre-Employment Onboarding Standardization efforts.
• Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.
• Assists JMG Operations with Enterprise Pre-Employment Onboarding Standardization efforts.
• Processes applications including collecting necessary documentation for credentialing/re-credentialing, human resources and billing, and arranging/preparing packets for medical staff onboarding.
• Coordinates credentialing and privileging procedures for initial and reappointment of Medical Staff and APPs, as needed, in accordance with Medical Staff Bylaws, Rules and Regulations and State and Federal law.
• Maintains confidential credentials and peer files and electronic medical staff database and reports align with resources such as NPDB, ABMS, AMA profiles etc.
• Conducts primary source verification, collects and validates documents to ensure accuracy of all credentialing elements. Assessed completeness of information.
• Prepares, issues, electronically tracks and follows up on appropriate verification for efficient, high volume processing of individual applications in accordance with applicable credentialing standards, established procedural guidelines and strict timeliness.
• Other duties as assigned.

QUALIFICATIONS:

• High School diploma or equivalent preferred; 3+ years related experience required
• Excellent computer skills including proficiency in Word, Excel, website and database management;
• Excellent written and verbal communication skills; excellent interpersonal skills and willingness to be a team player;
• knowledge of medical terminology and organization of medical care; excellent customer service skills.

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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.