Number of Positions In Requisition

1

Job Details

Working under the direct supervision of the Supervisor, Provider Database Maintenance, perform provider database maintenance duties to ensure the managed health care system reflects accurate and updated provider demographic information for all participating and non-participating providers. This includes, but is not limited to:
Physicians and other Individual Providers
Ancillaries
Facilities
Hospital-based
Facility-based

Job Description

Summary
Working under the direct supervision of the Supervisor, Provider Database Maintenance, perform provider database maintenance duties to ensure the managed health care system reflects accurate and updated provider demographic information for all participating and non-participating providers. This includes, but is not limited to: Physicians and other Individual Providers Ancillaries Facilities Hospital-based Facility-based

Job Duties

• Able to work in a constant state of alertness and safe manner
• Maintain and foster a collaborative relationship with internal and external customers.
• Precisely complete all Claims and Reconsideration Service Forms according to department’s service-level agreement with Claims
• Precisely complete Credentialing, PDC, and Finance service forms according to expected levels of quality and timeliness
• Enter demographic data of new providers (as noted above) into provider network database and assign fee schedule and related pricing/contract information.
• Make necessary changes to demographic and pricing/contract data for existing providers (as noted above).
• Retrieve, validate and perform any necessary updates based on production reports for all providers as noted above. Reports include, but are not limited to: * Credentialing to Claims system mismatch * Members attached to terminated PCPs * Active providers with sanctions * Encounter errors
• Identify and report possible problems with the provider network database files.
• Participate in ongoing projects, as necessary, and in staff and/or committee meetings and training.
• File provider information and documentation in designated areas and with Document Control, if necessary
• Utilize credentialing system inquiry functions to help maintain correct data for participating providers in the provider network database.
• Perform other job duties as required by Network Management.

Minimum Qualifications

• High School Diploma/GED
• Database, organizational, written and verbal communication skills, and ability to work independently or as part of a team.
• Strong relational database experience, health insurance industry preferred.
• Proficient in Microsoft Outlook and working knowledge of Microsoft Excel or Access, and MS Word.

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.

Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc.

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

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. 

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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