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Reference #: 9307197 Responsible for the operations of Jefferson Medical Group (JMG) Central Enrollments department (health plan enrollment) and physician credentialing function. This includes management of the Delegated Credentialing process by contractual obligations with major health plans; as well as direct oversight of the Delegated Provider Enrollment process, this management encompasses all credentials data and related documentation, scanning and maintenance of files for JMG physicians including the Management Services Organization (MSO) outside clients who pay for the services of JMG Central Enrollments. 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. About Jefferson 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#39;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 Co merce, 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 educashy;tional 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. Covid Vaccination is a requirement for employment at Jefferson for employees working at Jeffersonrsquo;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. 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. Certified Provider Credentialing Specialist (CPCS) 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.

As an employer, the Jefferson Enterprise 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.