Provider Enrollment & Credentialing Representative

Job Functions, Duties, Responsibilities and Position Qualifications:

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This position can be remote.

In this role you will:

Accountable for the initiation of new credential files, ensuring the completeness of a new application as the first step in the credentials verification process, and participating in verification of credentials through correspondence, phone contact, internet sites and any other third party vendor.

• Initial credentialing and re-credentialing of physicians.

• Obtains Medical Licenses as required, as well as ensures that all Sonic 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.

• Processes requests for Provider Enrollment ensuring compliance with criteria outlined in descriptions for both commercial and Government payers.

• Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing issues as they arise.

• Coordinate all managed care credentialing activities to ensure provider participation status. Credentialing activities require substantial contact with outside agencies.

• Remains current on policies affecting physician credentials and enrollment processes.

• Maintains strictest confidentiality

• Complies with all State, Federal, professional regulations as well as company and departmental rules, polices, and procedural manuals

• Adherence to HIPAA, Safety and OSHA Regulations

All you need is:

• 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

Scheduled Weekly Hours:

40

Work Shift:

Job Category:

Administration

Company:

Sonic Healthcare USA, Inc

Sonic Healthcare USA is an equal opportunity employer that celebrates diversity and is committed to an inclusive workplace for all employees. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, age, national origin, disability, genetics, veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.