Credentialing Associate

Job Description

Associates in this role get to: Support the team: Assist with training and quality assurance of peer staff -Coach, Mentor, Grow. Improve the company: Resolve problems and administrative issues. Fix problems. Promote success. Keep things running: Keep accurate data for requested monthly URAC (Utilization Review Accreditation Committee) report; Create accurate daily inventory report for manager. Report what’s important. Support ongoing growth. Take the lead: Lead staff in the absence of the manager. Lead on the fly, succeed naturally. Keep Sutherland aligned: Receive applications, assure completeness and verify credentials; Maintain accurate initial and re-credential files, monitoring at least 20 files per week; Create and maintain provider files within the database. Impact the bottom line: Call provider offices and U.S. licensing boards for missing information; confirm accuracy of data that has been presented.

Qualifications

Our most successful candidates will have: - Full working knowledge of provider credentialing and current URAC standards - High School Diploma or equivalent (Bachelor’s Degree preferred) - Five or more years of experience in Healthcare Operations - Three or more years of experience Credentialing / Re-credentialing Providers (preferred) - Two or more years of experience working in a Healthcare setting handling high level provider related issues - One or more years of experience in calling provider offices - Proficient level skills with MS office suite (Word and Excel) - Working knowledge of desk top PCs and Provider software - Broad understanding of Health insurance programs and HIPAA regulations - Experience in managing provider databases - Understanding of all SLAs that are in the Clients agreement; day-to-day receipts and ageing reports from the inventories

Additional Information

All your information will be kept confidential according to EEO guidelines.

EEOC and Veteran Documentation
During employment, employees are treated without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap, or any other legally protected status.
At times, government agencies require periodic reports from employers on the sex, ethnicity, handicap, veteran and other protected status of employees. The purpose of this Administrative EEO Record is for statistical analysis only and is used to comply with government record keeping, reporting, and other legal requirements. Periodic reports are made to the government on the following information. The completion of the Administrative EEO record is optional. If you choose to volunteer the requested information, please note that all 
Administrative EEO Records are kept in a Confidential File and are not part of your Application for Employment or Personnel file.
Please note: YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT ANY EMPLOYMENT DECISION.