Provider Enrollment and Credentialing Representative

Job Functions, Duties, Responsibilities and Position Qualifications:

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!

Quality is in our DNA -- is it in yours?

You are a superhero when it comes to patient specimens. You’ve got problem-solving instincts, a passion for patient care, and the drive to keep things running smoothly. You’re also looking for great benefits, the support of an all-star team, and an opportunity to grow your career.

Join our front line of #HealthcareHeroes! Our mission is to advance the health and wellbeing of our communities as a leader in clinical laboratory solutions.

Location: Remote

Full-time: Benefit Eligible

Days: Monday - Friday

Hours: 8:00 AM - 5:00 PM

In this role, you will:

The Provider Enrollment & Credentialing Representative will be mainly responsible for MD/DO license maintenance, and to make sure CMEs are collected and maintained in a timely manner. Other responsibilities may include 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.                 

• Initial credentialing and re-credentialing of physicians.

• Obtains Medical Licenses as required, as well as ensures that all medical staff meet and maintain active licensure.

• CME Maintenance

• 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.

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All you need is:

• 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.

We’ll give you:

• 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, including Paid Time Off and 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!

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.