Penn Medicine is looking for a Credentialing Evaluation Coordinator, for the Office of Medical Affairs!
• Evaluation Management team reviews, resolves discrepancies, and performs quality improvement for the provider credentialing/recredentialing process that directly affects UPHS hospital's state licensure, JCAHO accreditation, CMS certification, and delegated provider enrollment agreements with managed care plans and the ability of UPHS providers to practice thereby directly impacting UPHS revenue generation. • Monitors and follows up with applicants to ensure timely completion of the credentialing process, as well as ensuring that all required documentation is received in order to move the file to the chair review process. • Manage the credentialing approval process
Minimum Degree Requirements and Experience Required: • High School Diploma or GED required. • Minimum five years experience in credentialing either in a managed care, hospital or related setting required.
Skill Requirements: • Must have a complete understanding of all regulatory standards and business rules. • Proficient in computers and computer software including, but not limited to, database management, spreadsheet and word processing applications. Advanced training in database management preferred. • Detail oriented, – must be analytical and able to assimilate large amounts of information, draw conclusions, identify and resolve discrepancies. • Must be able to work independently, and also exercise good judgment when escalating issues to management. • Must also be able to work effectively as a member of a larger team. • Must have the ability to maintain information in a confidential manner in accordance with all regulatory requirements • Communication skills - oral/written with physicians and external contacts. • Must be able to meet deadlines.
About Penn Medicine (Univ of Pennsylvania Health System)
Penn Medicine is committed to remain a world-leading institution in three equally valued and inter-related missions of patient care, education, and research. The success of these missions requires the integration of the School of Medicine and Health Services and a shared destiny with the University of Pennsylvania. By recruiting and retaining a world-class faculty and staff who strive for excellen...ce, innovation, quality, and professionalism, we will accomplish our missions. Our goal is to be recognized nationally as the most accomplished and respected School of Medicine and Health System.
A leader in medicine for more than 240 years, Penn opened its School of Medicine, the nation's first, in 1765. The Hospital of the University of Pennsylvania was established in 1874 as the nation's first teaching hospital. The system includes 3 additional hospitals, Penn Presbyterian Hospital, Pennsylvania Hospital (the nation's first hospital), and Chester County Hospital. Physician groups include the 1500-member Clinical Practices of the University of Pennsylvania and Clinical Care Associates.