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Description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

**Job Title:** Credentialing Compliance Coordinator

**Department:** Neurology Administration

**Location:** Hospital of the University of Pennsylvania - 3400 Spruce St

**Hours:** Mon-Fri office hours

Summary:

+ Submit and track the credentialing process for new clinical practice providers in the Department.•Ensure licensure and regulatory requirements are met to facilitate the credentialing process.•Support the onboarding requirements that directly impact the ability of UPHS to bill for services rendered by the health care providers; thereby, directly impacting UPHS' revenue generation process. Involves working with the department billing specialists to resolve enrollment edits attributed to an Office of Medical Affairs (OMA) issue. Knowledge and access to PennMAPP for data entry/system updates. •Set up and maintain the clinical personnel files consistent with UPHS and regulatory compliance standards.•Support the Chair or the designee to complete the Focused Professional Practice Evaluation (FPPE) process and maintain the Ongoing Professional Practice Evaluation (OPPE) process on a timely basis.•Perform license verification consistent with UPHS and regulatory compliance standards.•Work closely with various Department individuals and teams, across all levels, on matters regarding credentialing, enrollment, and professional file maintenance to assure compliance.

Responsibilities:

+ PROCESS MANAGEMENT: Provider Credentialing, Enrollment, and Regulatory Compliance Data Management.

+ Coordinate the intake and input of the New Provider Credentialing Request both through the Department contact and the OMA Applications Request system.

+ Consistent follow-up with the new provider to ensure credentialing process efficiency and expediency. This includes ensuring licensure and regulatory requirements are met.

+ Effective use of the PennMAPP system for data entry and follow-up. This includes maintaining proficiency in the utilization of credentialing and enrollment applications.

+ Work with the Department, providers and OMA staff to ensure correctness and completeness of requests so that claims will ultimately be paid by payers in a timely and accurate manner. Enrollment requests include new practice set-up, and provider-specific transactions (initial enrollment, changes and terminations).

+ Work with practices to resolve issues causing enrollment edits so that claims are released to health plans for payment before timely filing limits.

+ Responsible for ensuring that data in the enrollment system is accurate and complete in order to support the OMA enrollment function.

+ Set up and maintain the clinical personnel files for the clinical practices consistent with UPHS and regulatory compliance standards. This includes, and is not limited to, current CV, PATCH report, fingerprinting/FBI Clearance, Professional License, Board Certification, DEA certification, Competencies, Performance Evaluations, Annual Mandatory Education completion, CPR certification, annual flu vaccination, and annual Billing Compliance completion.

+ Perform professional license verification consistent with UPHS and regulatory compliance standards.

+ Support the Chair or the designee to complete the Focused Professional Practice Evaluation (FPPE) process and maintain the Ongoing Professional Practice Evaluation (OPPE) process on a timely basis. This includes, and is not limited to, emailing communications on behalf of the designee, obtaining required signatures, scanning completed forms, and maintaining a database of the evaluation status for administrative review/internal audit.

+ Assist with regulatory inspections by providing required elements of a provider’s personnel file on a timely basis.

+ Provide copies of malpractice insurance face sheets to providers as requested.

+ Collect proof of liability/malpractice coverage for providers not registered through Penn’s malpractice insurance.

+ Notify/educate practice management and department billing staff regarding changes to the credentialing and/or enrollment processes.

Education or Equivalent Experience:

+ Associate of Arts or Science (Required)

+ And 5+ years in a healthcare setting with extensive customer service and excellent communication skills (Required)

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

Live Your Life's Work

We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.

REQNUMBER: 278109