Credentialing Specialist Resume
Objective : Dedicated Credentialing Specialist with two years of experience in verifying qualifications, maintaining compliance, and enhancing operational efficiency. Proven ability to manage multiple credentialing processes while ensuring adherence to state and federal regulations. Committed to fostering strong relationships with healthcare professionals to support optimal patient care.
Skills : Data Management Software, Credentialing Processes, Data Entry Accuracy, Regulatory Compliance
Description :
- Conducted thorough analysis and verification of immunizations and training certifications to ensure compliance.
- Managed multiple credentialing queues, including TB and drug screening documentation.
- Provided training to colleagues on corporate accounts and compliance standards.
- Fostered relationships with account managers to streamline the credentialing process.
- Maintained accurate documentation during peak seasons through effective multitasking.
- Processed and managed documentation within a 24-72 hour timeframe.
- Led corporate training initiatives, enhancing employee understanding of credentialing requirements.
Experience
0-2 Years
Level
Entry Level
Education
B.S. H.A.
Senior Credentialing Specialist Resume
Headline : Seasoned Credentialing Specialist with over 7 years of expertise in managing comprehensive credentialing processes and ensuring regulatory compliance. Adept at utilizing technology to enhance data accuracy and streamline workflows. Passionate about building effective relationships with healthcare providers to promote quality patient care and operational excellence.
Skills : Verification Techniques, Policy Development, Team Collaboration, Training And Development, Conflict Resolution
Description :
- Oversee the complete credentialing and recredentialing process, ensuring data integrity across multiple systems for healthcare providers and allied health professionals.
- Ensure compliance with regulatory and accreditation standards by interpreting relevant laws and guidelines effectively.
- Maintain accurate provider data using CAQH and other credentialing applications, facilitating timely provider onboarding.
- Monitor and manage credentialing applications, ensuring thorough follow-up and timely resolution of issues.
- Maintain up-to-date knowledge of health plan requirements and manage corporate provider contract files accordingly.
- Establish and maintain provider information in credentialing databases, including Cactus, OmniFlow, and Xcelys, ensuring accuracy and accessibility.
- Collaborate with cross-functional teams to enhance credentialing processes and resolve discrepancies efficiently.
Experience
5-7 Years
Level
Senior
Education
B.S. HCA
Credentialing Specialist Resume
Summary : With a decade of experience in credentialing, I excel in validating professional qualifications and ensuring compliance with healthcare regulations. My expertise lies in streamlining credentialing processes, enhancing data integrity, and fostering effective communication with healthcare providers. I am dedicated to improving operational efficiency and contributing to high-quality patient care.
Skills : Credentialing Software Proficiency, Data Analysis And Reporting, Project Management, Adaptability, Critical Thinking, Negotiation Skills
Description :
- Facilitated the credentialing and recredentialing of healthcare providers, ensuring timely and compliant submissions.
- Coordinated application processes in collaboration with reimbursement specialists to enhance efficiency.
- Updated insurers on provider participation changes, ensuring accurate records and compliance.
- Acted as a liaison between providers and insurers, resolving application inquiries efficiently.
- Maintained detailed physician files, ensuring all documentation was current and accurate.
- Managed a comprehensive database of credentialing information to support audits and reporting.
- Engaged with physicians daily to address concerns and promote positive relationships.
Experience
7-10 Years
Level
Management
Education
B.S. Health Admin.
Lead Credentialing Specialist Resume
Headline : With over 7 years of specialized experience in credentialing, I excel at ensuring compliance with healthcare regulations while effectively managing complex credentialing workflows. My expertise includes fostering productive relationships with healthcare providers and optimizing operational processes to enhance efficiency and patient care outcomes.
Skills : Interpersonal Skills, Problem-solving Skills, Time Management, Organizational Skills, Communication Skills, Confidentiality Practices
Description :
- Oversee the credentialing process for approximately 275 new residents and fellows annually, ensuring timely onboarding.
- Manage ongoing services for around 1,400 residents and fellows, maintaining compliance with licensing requirements.
- Process Visa applications and verify National Practitioner Data Bank (NPDB) licensure.
- Conduct background checks and log drug screening results to uphold safety standards.
- Act as a liaison between residents/fellows and the Benefits and Payroll departments for direct deposit setups.
- Facilitate recertification of ACLS and BLS for staff, coordinating with Learning Network and House Staff officers.
- Prepare documentation and generate contracts for residents, ensuring accuracy and compliance.
Experience
5-7 Years
Level
Management
Education
B.S. in HA
Credentialing Specialist Resume
Objective : Proficient Credentialing Specialist with two years of dedicated experience in verifying qualifications and ensuring compliance with healthcare regulations. Skilled in managing credentialing workflows and enhancing operational effectiveness. Passionate about building collaborative relationships with healthcare providers to facilitate optimal patient care outcomes.
Skills : Process Improvement, Audit Preparation, Risk Management, Credentialing Software, Health Insurance Knowledge, Legal Compliance
Description :
- Managed the accurate entry and maintenance of data in credentialing databases, preparing reports for the Medical Management Committee.
- Communicated regularly with providers to update them on credentialing status, ensuring timely follow-ups for missing information.
- Built and maintained strong professional relationships with healthcare providers and internal teams.
- Collaborated with multiple departments to meet client service obligations as per contract agreements.
- Identified opportunities for process improvements and presented recommendations to the Compliance Manager.
- Maintained thorough knowledge of credentialing operations and regulatory requirements.
Experience
0-2 Years
Level
Entry Level
Education
B.S. HIM
Junior Credentialing Specialist Resume
Objective : Skilled Junior Credentialing Specialist with 5 years of experience in processing and verifying provider credentials. Proficient in ensuring compliance with healthcare regulations and streamlining workflows. Committed to enhancing operational efficiency and fostering strong relationships with healthcare professionals to support quality patient care.
Skills : Quality Assurance, Report Generation, Research Skills, Medical Terminology
Description :
- Responsible for processing provider applications, credentialing, re-credentialing, and primary source verification for Commercial Tricare accounts.
- Conduct audits to ensure timely and accurate credentialing of all providers.
- Review systems to assess provider network status and compliance.
- Engage with providers for missing information via phone, fax, or letter.
- Input and maintain provider credentialing data in the Vistar system.
- Collaborate with PSV Coordinator to establish verification resources, including NPDB and criminal background checks.
- Managed provider credentialing processes to ensure compliance with regulatory standards.
Experience
2-5 Years
Level
Junior
Education
B.S. in HA
Credentialing Specialist Resume
Summary : Bringing a robust ten years of experience in credentialing, I specialize in validating healthcare provider qualifications and ensuring compliance with regulatory standards. My proven track record in streamlining credentialing workflows and enhancing data accuracy positions me as a key contributor to operational excellence and quality patient care.
Skills : Software Proficiency, Record Keeping, Workflow Optimization, Stakeholder Engagement, Credential Verification, Licensing Knowledge
Description :
- Acted as the primary point of contact for credentialing within the Texas Army National Guard, ensuring regulatory compliance.
- Managed provider files in strict accordance with Army regulations and HIPAA standards.
- Advised on adverse actions against non-compliant providers to the State Army Surgeon.
- Coordinated and facilitated credentialing boards for provider privileging.
- Engaged with providers to support mission readiness and compliance.
- Maintained and updated a database tracking certifications and training for over 200 Healthcare Specialists.
- Ensured compliance in medical records management, including electronic filing and HIPAA adherence.
Experience
7-10 Years
Level
Management
Education
B.S. Health Admin.
Assistant Credentialing Specialist Resume
Objective : With five years of dedicated experience in credentialing, I excel in validating healthcare provider qualifications and ensuring compliance with industry regulations. My expertise encompasses managing credentialing workflows, enhancing data integrity, and fostering effective communication with practitioners. I am committed to supporting optimal patient care through meticulous credentialing processes.
Skills : Multi-tasking Ability, Analytical Skills, Technical Proficiency, Verification Processes, Attention To Detail, Insurance Knowledge
Description :
- Facilitated credentialing workflows for healthcare practitioners, ensuring timely processing and compliance with regulations.
- Represented the department in committee meetings, advocating for best practices in credentialing.
- Served as a liaison between healthcare providers, insurance plans, and facilities to streamline communication.
- Reviewed and processed credentialing applications, maintaining confidentiality and accuracy of sensitive information.
- Communicated directly with medical practitioners to clarify documentation requirements and expedite applications.
- Maintained provider data in online credentialing databases, ensuring real-time accuracy and accessibility.
- Tracked and managed certification and licensure expirations to facilitate timely renewals.
Experience
2-5 Years
Level
Executive
Education
B.S. in HA
Credentialing Specialist Resume
Headline : Accomplished Credentialing Specialist with over 7 years of experience in overseeing comprehensive credentialing operations. Expertise in ensuring compliance with regulatory standards and optimizing workflows for enhanced efficiency. Dedicated to building strong partnerships with healthcare providers to elevate patient care and streamline credentialing processes.
Skills : Document Management Software, Statistical Analysis, Email Communication Management, Regulatory Updates, Healthcare Credentialing Software, Credentialing Workflow Management
Description :
- Manage the credentialing and re-credentialing process for Medical and Allied Health Professionals, ensuring accuracy and regulatory compliance.
- Conduct primary source verification for providers per NCQA standards and relevant regulations.
- Monitor and maintain current licenses, DEA, and malpractice coverage for all credentialed providers.
- Generate and analyze credentialing reports utilizing Cactus and QNXT software.
- Input and update provider information in CAQH, ensuring data integrity and compliance.
- Research potential sanctions and prepare reports for the Credentialing Committee review.
- Perform administrative support tasks, including correspondence management and documentation filing.
Experience
5-7 Years
Level
Senior
Education
B.S. Health Admin
Associate Credentialing Specialist Resume
Summary : As a Credentialing Specialist with a decade of comprehensive experience, I excel in validating provider qualifications and ensuring strict adherence to healthcare regulations. My expertise encompasses optimizing credentialing workflows, enhancing data accuracy, and nurturing collaborative relationships with healthcare professionals to deliver exceptional patient care.
Skills : Credentialing Management, Record Management, Document Management, Customer Service
Description :
- Reviewed and verified provider documentation to ensure compliance with credentialing standards.
- Coordinated the credentialing and re-credentialing processes, managing all necessary documentation.
- Maintained comprehensive provider files, including licenses, certifications, and insurance information.
- Acted as a liaison between providers and internal departments to facilitate information exchange.
- Ensured accuracy and completeness of applications before submission to management and committees.
- Communicated credentialing status updates to providers and stakeholders efficiently.
- Managed incoming applications, ensuring timely processing and adherence to deadlines.
Experience
7-10 Years
Level
Executive
Education
B.S. in HA
Credentialing Specialist Resume
Objective : With two years of hands-on experience in credentialing, I excel in verifying qualifications and ensuring compliance with healthcare regulations. My focus on accuracy and operational efficiency enhances provider workflows, while my strong communication skills foster productive relationships with healthcare professionals to support quality patient care.
Skills : Data Analysis, Documentation Skills, Patient Safety Standards, Compliance Audits, Credentialing Standards
Description :
- Ensured timely re-credentialing of providers to maintain compliance.
- Performed verification of provider credentials, including licenses, medical education, and residency training.
- Established and maintained provider files in compliance with client specifications.
- Coordinated credentialing for physicians through written source verification.
- Ensured up-to-date documentation for each physician's credentials.
- Assisted physicians in acquiring state-specific medical licenses.
- Processed privileging applications for locum tenens assignments efficiently.
Experience
0-2 Years
Level
Entry Level
Education
B.S. in HA
Credentialing Specialist Resume
Objective : Detail-oriented Credentialing Specialist with over 5 years of experience in verifying qualifications and ensuring compliance with regulatory standards. Proven track record in managing credentialing processes, maintaining accurate records, and collaborating with healthcare providers to streamline operations. Strong analytical skills and a commitment to upholding the highest standards of quality and integrity in credentialing.
Skills : Training And Mentoring, Regulatory Compliance Knowledge, Professional Ethics, Technical Writing, Networking Skills
Description :
- Served as the primary liaison between healthcare providers, human resources, and insurance companies to facilitate credentialing processes.
- Executed thorough reference checks and primary source verifications for licenses and certifications across 19 states.
- Managed the credentialing process for employment and insurance providers, ensuring compliance with state regulations.
- Obtained CLIA certificates for clinics, ensuring timely operations and compliance.
- Generated weekly credentialing reports for management to assess newly hired healthcare professionals' status.
- Resolved discrepancies in provider applications and documentation.
- Proactively notified staff of expiring licenses and certifications to maintain compliance with credentialing policies.
Experience
0-2 Years
Level
Entry Level
Education
BSHA
Credentialing Associate Resume
Objective : Accomplished Credentialing Associate with two years of expertise in validating provider qualifications and ensuring compliance with healthcare regulations. Skilled in managing credentialing workflows and enhancing operational processes while fostering effective relationships with healthcare professionals. Dedicated to streamlining operations to support high-quality patient care.
Skills : Powerpoint, Risk Assessment, Office Suite Proficiency, Insurance Verification
Description :
- Developed relationships with state licensing boards and professional organizations.
- Ensured timely processing of applications to minimize delays.
- Maintained demographic logs for twelve providers, ensuring accurate healthcare network statuses.
- Completed healthcare contracts for providers to participate in various health networks.
- Enrolled providers in different healthcare options, including HMO and PPO.
- Created National Provider Identifiers and completed CAQH applications.
- Managed and updated provider records in the Consolidated Provider File database.
Experience
0-2 Years
Level
Entry Level
Education
ASHS
Credentialing Associate Resume
Objective : Dedicated Credentialing Specialist with expertise in managing the credentialing lifecycle for healthcare professionals. Skilled in conducting thorough background checks, verifying licenses, and ensuring adherence to accreditation standards. Excellent communication and organizational skills, with a focus on improving processes and fostering positive relationships with medical staff and regulatory bodies.
Skills : Time-sensitive Tasks, Healthcare Regulations, Professional Networking, Client Relations, Ethical Standards, Database Analysis
Description :
- Managed the credentialing process for healthcare providers, ensuring all documentation met regulatory standards.
- Conducted thorough background checks and verified qualifications for new hires.
- Developed and implemented standard operating procedures for credentialing workflows.
- Maintained accurate and up-to-date records in the HR database for all credentialed individuals.
- Collaborated with internal departments to optimize the credentialing process and improve efficiency.
- Provided training and support to staff regarding credentialing requirements and processes.
- Assisted in compliance audits, ensuring adherence to industry regulations.
Experience
2-5 Years
Level
Junior
Education
B.S. in HA
Credentialing Associate Resume
Objective : Proficient Credentialing Associate with two years of experience in verifying provider qualifications and ensuring compliance with healthcare standards. Skilled in managing credentialing processes and enhancing operational workflows. My commitment to accuracy and effective communication fosters strong relationships with healthcare professionals, contributing to improved patient care outcomes.
Skills : Time-sensitive Decision-making, Patient Safety Focus, Presentation Skills, Follow-up Procedures
Description :
- Collaborated with vendors to streamline credentialing processes.
- Verified professional credentials to ensure compliance with industry standards.
- Provided exceptional customer service to providers and stakeholders.
- Created and maintained a comprehensive database for professional credentials.
- Responded to inquiries regarding credentialing status and processes.
- Conducted regular audits to maintain data accuracy in the credential database.
- Updated and researched credential information as required.
Experience
0-2 Years
Level
Entry Level
Education
B.S. in HA
Credentialing Associate Resume
Objective : Enthusiastic Credentialing Associate with two years of experience in validating provider qualifications and ensuring compliance with healthcare regulations. Skilled at coordinating credentialing processes and adept at fostering relationships with healthcare professionals. Committed to enhancing operational efficiency and supporting high-quality patient care through meticulous attention to detail.
Skills : Vendor Management, Continuous Learning, Database Accuracy, Database Management, Multi-tasking Abilities, Licensing Requirements
Description :
- Collaborated with cross-functional teams to ensure accurate credentialing data.
- Maintained comprehensive records of provider compliance with credentialing requirements.
- Created detailed documentation outlining credentialing processes for team reference.
- Managed the company's onsite verification program to enhance accuracy.
- Coordinated registration for industry events and ensured all credentialing information was submitted.
- Maintained an organized database of events and credentialing programs.
- Communicated updates and changes to credentialing policies to relevant stakeholders.
Experience
0-2 Years
Level
Fresher
Education
B.S. in HA
