Provider Enrollment and Credentialing Representative

Sonic Healthcare USA•Dallas, TX

1d•Onsite

About The Position

Sonic Healthcare USA is a Great Place to Work certified employer dedicated to creating a supportive and inclusive environment that emphasizes teamwork and innovation. We are seeking a Provider Enrollment & Credentialing Representative to join our team. This role is crucial for initiating new credential files, ensuring application completeness, and participating in the verification of credentials. The ideal candidate will have a passion for patient care, problem-solving instincts, and a drive to keep operations running smoothly. Our mission is to advance the health and wellbeing of our communities as a leader in clinical laboratory solutions.

Requirements

Bachelor’s Degree or the equivalent years of experience.
Prior years of 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.

Responsibilities

Initiate new credential files, ensuring the completeness of new applications as the first step in the credential's verification process.
Participate in the verification of credentials through correspondence, phone contact, internet sites, and any other third-party vendor.
Perform initial credentialing and re-credentialing of physicians.
Obtain Medical Licenses as required and ensure all 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.
Coordinate and monitor the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
Conduct thorough background investigations, research, and primary source verification of all components of the application file.
Identify issues that require additional investigation and evaluation, validate discrepancies, and ensure appropriate follow-up.
Prepare credentials files for completion and presentation to Entity Credentialing Committees, ensuring file completion within specified time periods.
Responsible for CAQH files for providers to ensure completion and maintain revisions/updates.
Process requests for Provider Enrollment ensuring compliance with criteria outlined in descriptions for both commercial and Government payers.