Provider Enrollment and Credentialing Representative
Core
Initiating and verifying new provider credential files, ensuring completeness of applications, and coordinating verification through correspondence and third-party vendors.
Role type
Provider Enrollment and Credentialing Representative
Builds
Credentialing files for physicians and other medical staff to enable participation in commercial and government payer networks.
Domain
Healthcare Administration / Medical Credentialing
Required skills
Medical terminology, insurance billing processes, credentialing and licensing procedures, primary source verification, background investigation, CAQH file management, payer compliance criteria.
Preferred skills
Problem-solving for complex planning and coordination, knowledge of Aurora Medical staff licensure requirements.
Responsibilities
Initial and re-credentialing of physicians, obtaining and maintaining medical licenses, coordinating review of practitioner applications, conducting background investigations, preparing credentials files for Entity Credentialing Committees, managing CAQH files, processing provider enrollment requests for commercial and government payers.
Seniority
Mid-level, hands-on IC
