Credentialing Coordinator - Dallas, Texas

About the role

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.

Responsibilities

• 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

Qualifications

• 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

Schedule

• Full-time, benefit eligible
• Days: Monday - Friday
• Hours: 8:00 AM - 5:00 PM
• Work Shift: 40 scheduled weekly hours

Benefits

• 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!