Location: Palm Beach Gardens, Florida
Admin / Clerical
Internal Number: REQ-020783
Job Functions, Duties, Responsibilities and Position Qualifications:
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.
Full-time: Benefit Eligible
Days: Monday - Friday
Hours: 8:00 AM - 4:30 PM
Essential Key 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.
- 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
Sonic Anatomic Pathology
Scheduled Weekly Hours:
Aurora Diagnostics LLC
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.