Provider Enrollment & Credentialing Representative

Sonic Healthcare USA • Dallas, TX

21h

About The Position

We're not just a workplace - we're a Great Place to Work certified employer! Proudly certified as a Great Place to Work, we are dedicated to creating a supportive and inclusive environment. At Sonic Healthcare USA, we emphasize teamwork and innovation. Check out our job openings and advance your career with a company that values its team members! 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.

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
• Evidence of the practice of a high level of confidentiality
• Ability to analyze complex reports and spreadsheets
• Ability to organize priorities and projects
• Ability to work proactively with little supervision
• Ability to understand and work in a complex, multi-practice setting
• Ability to demonstrate proficiency in data entry and keyboarding skills, Microsoft Word and Excel

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level