Provider Enrollment and Credentialing Representative
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 primarily responsible for MD/DO license maintenance and ensuring timely collection and maintenance of CMEs. Other responsibilities include initiating new credential files, ensuring application completeness, and verifying credentials through various methods. The ideal candidate will have a passion for patient care, problem-solving instincts, and a drive to keep things running smoothly, while also seeking great benefits and career growth opportunities.
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
Responsibilities
- MD/DO license maintenance
- Ensure CMEs are collected and maintained in a timely manner
- Initiation of new credential files
- Ensure completeness of new applications
- Participate in verification of credentials through correspondence, phone contact, internet sites, and any other third-party vendor
- 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 (excluding CLIA licenses)
- Coordinate, and monitor the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility
- Conduct thorough background investigation, 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 file 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
Benefits
- Appreciation for your work
- A feeling of satisfaction that you’ve helped people
- Opportunity to grow in your profession
- Free lab services for you and your dependents
- Work-life balance
- Paid Time Off
- Paid Holidays
- Competitive benefits including medical, dental, and vision insurance
- Help saving for retirement, with a 401(k) plus a company match
- A sense of belonging – we’re a community!
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
