Lead Analyst Job at Jefferson - Center City, Philadelphia, PA
Jefferson - Center City, Philadelphia, PA Philadelphia, PA 19107
Job Summary:
Responsible for credentialing employed JMG (Jefferson Medical Group) and JeffCare PHO physicians according to National Committee for Quality Assurance (NCQA). Work with Jefferson Medical Staff offices at the Enterprise level to ensure credentialing documentation is shared and coordinated as part of the JeffCare Credentialing Process. The candidate is responsible for coordinating data elements and be expected to lead in the area of special projects. Effective time management will enable the individual to assign files and ensure files are brought to committee in a timely manner. This individual would be expected to perform quality reviews, audits, training, and update associated documents. The Senior analyst will be responsible for a number of work efforts designed to improve the overall revenue impact of the company. Individual should be keenly aware of enterprise collaboration and impacts and lead and recommend improvements designed to improve the financial bottom line. Senior would be expected to coordinate and assist.
Essential Functions:
- Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.
Perform quality review of analysts work to ensure an ongoing standard of credentialing - and overall improvement to revenue. Review claims hold edits to ensure staff follow up on work processes. Provide findings to leadership and recommends to the staff regarding the quality and productivity of work
Perform audits of files in preparation for committee meeting - review and prepare departmental plan audits for delegated payers
Oversee the integrity of the Delegation agreement as dictated in contractual and regulatory documents identifying any issues, concerns and recommendations. Manage and Present at the JeffCare Credentialing meetings (agena, recordings, minutes, etc..)
Prepare individual physician credentialing files in accordance with all established standards. Update and maintain demographic and credentialing information in database. Manage files directly during peak season and during special projects.
Minimum Education and Experience Requirements:
Education:
HS Diploma required, Associates/Bachelors in Health Care Adm strongly preferred
AND
Experience:
Certified Credentialing Specialist (CPCS), Experience with Cactus or ECHO. Individual should have demonstrated ability to improve outcomes via recommended improvements. Special projects and training a plus.
Additional Information:
- 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. Demonstrated ability to effectively lead individuals to an expected outcome.
Covid Vaccination is a requirement for employment at Jefferson for employees working at Jefferson’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.
Jefferson includes Thomas Jefferson University and Jefferson Health, a dynamic university and health system with broad reach across the Delaware Valley. Jefferson is the second largest employer in Philadelphia and the largest health system in Philadelphia based on total licensed beds.
Through the merger of Thomas Jefferson University and Philadelphia University in 2017, our University includes ten colleges and four schools. We are an NCAA Division II university and an R2 national doctoral university offering undergraduate and graduate-level programs that provide students with a forward-thinking education in architecture, business, design, engineering, fashion and textiles, health, medicine and social science.
Jefferson Health, the clinical arm of Thomas Jefferson University, has grown from a three-hospital academic health center in 2015, to an 18-hospital health system through mergers and combinations that include hospitals at Abington Health, Aria Health, Kennedy Health, Magee Rehabilitation and Einstein Healthcare Network. We have over 50 outpatient and urgent care centers; ten Magnet®-designated hospitals (recognized by the ANCC for nursing excellence); the NCI-designated Sidney Kimmel Cancer Center (one of only 70 in the country and one of only two in the region); and one of the largest faculty-based telehealth networks in the country. In 2021, Jefferson Health became the sole owner of HealthPartners Plan, a not-for-profit health maintenance organization in Southeastern Pennsylvania. We are the first health system regionally to create an aligned payer-provider partnership.
Jefferson’s mission, vision and values create an organization that attracts the best and the brightest students, faculty, staff, and healthcare professionals, as well as the most visionary leaders to drive exceptional results.
- OUR MISSION: We improve lives.
- OUR VISION: Reimagining health, education and discovery to create unparalleled value
- OUR VALUES: Put People First, Be Bold & Think Differently and Do the Right Thing
As an employer, Jefferson 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.
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