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.