Provider Enrollment and Credentialing Representative
About The Position
The Provider Enrollment & Credentialing Representative will be accountable for the initiation of new credential files, ensuring the completeness of a new application as the first step in the credential's verification process, and participating in verification of credentials through correspondence, phone contact, internet sites and any other third-party vendor. In this role you will: Initial credentialing and re-credentialing of physicians. Obtains Medical Licenses as required, as well as ensures that all Aurora Medical staff meet and maintain active licensure. Oversee the maintenance of all certifications required to successfully license and credential all physicians with the exception of the laboratory’s CLIA licenses. Coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility. Conducts thorough background investigation, research and primary source verification of all components of the application file. Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up. Prepares credentials file for completion and presentation to Entity Credentialing Committees, ensuring file completion within time periods specified. Responsible for CAQH files for providers to ensure completion and maintain revisions/updates. Processes requests for Provider Enrollment ensuring compliance with criteria outlined in descriptions for both commercial and Government payers.
Requirements
- Bachelor’s Degree or the equivalent years of experience.
- Four years related experience; or equivalent combination of education and experience.
- Ability to solve complex problems to support the planning, organizing, and coordinating of provider payer credentialing.
- Knowledge of medical terminology, insurance billing, credentialing and licensing processes as demonstrated by work experience and education.
- Must be able to effectively respond to questions from managers, employees, and outside entities.
Responsibilities
- Initial credentialing and re-credentialing of physicians.
- Obtains Medical Licenses as required, as well as ensures that all Aurora Medical staff meet and maintain active licensure.
- Oversee the maintenance of all certifications required to successfully license and credential all physicians with the exception of the laboratory’s CLIA licenses.
- Coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
- Conducts thorough background investigation, research and primary source verification of all components of the application file.
- Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
- Prepares credentials file for completion and presentation to Entity Credentialing Committees, ensuring file completion within time periods specified.
- Responsible for CAQH files for providers to ensure completion and maintain revisions/updates.
- Processes requests for Provider Enrollment ensuring compliance with criteria outlined in descriptions for both commercial and Government payers.
Benefits
- Free lab services for you and your dependents
- Work-life balance, including Paid Time Off and Paid Holidays
- Competitive benefits including medical, dental, and vision insurance
- Help saving for retirement, with a 401(k) plus a company match
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
