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 advancing the health and wellbeing of our communities as a leader in clinical laboratory solutions. The ideal candidate will have problem-solving instincts, a passion for patient care, and the drive to keep things running smoothly, while also seeking great benefits and career growth opportunities.

Requirements

Bachelor’s Degree or 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 and ensure their completeness as the first step in the credential's verification process.
Participate in the verification of credentials through correspondence, phone contact, internet sites, and third-party vendors.
Perform initial credentialing and re-credentialing of physicians.
Obtain Medical Licenses as required and ensure physicians meet and maintain active licensure.
Oversee the maintenance of all certifications required to license and credential all physicians, excluding 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 requiring additional investigation and evaluation, validate discrepancies, and ensure appropriate follow-up.
Prepare credentials files for completion and presentation to Entity Credentialing Committees, ensuring completion within specified time periods.
Manage CAQH files for providers to ensure completion and maintain revisions/updates.
Process requests for Provider Enrollment, ensuring compliance with criteria for both commercial and Government payers.