Credentialing Coordinator Resume Samples

Working in healthcare facilities, the Credentialing Coordinator will undertake various administrative tasks pertaining to healthcare practitioner credentialing. Typical Credentialing Coordinator Resume mentions the following duties – processing initial credentialing/re-credentialing applications; collecting the needed information from various sources; screening practitioner’s applications and supporting documentation for ascertaining eligibility; identifying discrepancies; assisting customers with credentialing issues; ensuring backup of data; and adhering to applicable laws, regulations, policies and procedures. The job description also includes ensuring the accuracy of all files and documents by tracking license expiration.

The most sought-after qualifications for the post include – thorough knowledge of medical credentialing and its related procedures; strong communication skills, proficiency with MS Word; fast touch-typing skills; and ability to work for long hours. A high school diploma is the minimum educational requirement for this occupation. Relevant work experience and NAMSS certification are also required.

Credentialing Coordinator Resume

Objective : Self-motivated individual with excellent computer software and customer service experience 70 wpm Ability to multi-task and work in a fast-paced environment. Learning new concepts quickly, working well under pressure, and communicating ideas clearly and effectively Attentive to detail Interpersonal communication skills.

Skills : Credentialing, Provider Relations, Provider Enrollement, Executive Support.

Description :

    1. Over 150 members Coordinates, oversees, and administers the credentialing and privileging process for all WKHS medical providers, in accordance with NCQA, and CMS accreditation standards, Federal and State laws.
    2. Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
    3. Conducts thorough background investigation, research and primary source verification of all components of the application file.
    4. Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
    5. Prepares credentials file for completion and presentation to WKHS Credentialing Committee, ensuring file completion within time periods specified.
    6. Assists with managed care delegated credentialing audits; conducts internal file audits.
    7. Utilizes the credentialing database, optimizing efficiency, and performs query, report and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act.
    8. Monitors credentialing, recredentialing, and ongoing monitoring processes, ensuring compliance with regulatory bodies NCQA, CMS, as well as WKHS Bylaws, policies, procedures, and delegated contracts.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
Bachelors Of Science


Contracting/Credentialing Coordinator Resume

Summary : Detail-oriented, conscientious, proficient, and a dependable team player. I've been recognized by superiors and peers as a highly organized, hardworking professional with excellent communication skills, a strong work ethic and keen ability for multitasking in a fast paced environment, completing tasks within or ahead of schedule, always focusing on detail and proficiency.

Skills : Microsoft Office, 10-Key, Quickbooks, AHLTA, CHCS.

Description :

    1. Desk top audits and site audits of Physicians applications requesting to be Credentialed or Re-Credentialed as Scan Health Plan Physicians, verifying Licensure, Board Certifications, National Provider Data Bank.
    2. Prepare and submit recommendations regarding Credentialing and Re-Credentialing of Providers and Health Delivery Organizations, to the Credentialing Committee.
    3. Monitor Physicians who are on probation and implement monthly to yearly monitoring plan for the Provider Organization to assure the Physician is in compliance with terms of probation.
    4. Monitor weekly/monthly Physician Licensures, law suits and disciplinary actions, Exclusions from the Office of the Inspector General and the California Opt-Out reporting.
    5. Report all Adverse Actions to Chair of the Credentialing Committee, along with an explanation of occurrence and next course of action.
    6. Requesting the Medical Groups to monitor provider's compliance with Court Orders and maintaining the reports received monthly from the Medical Groups.
    7. Monitor all Provider Organizations Delegated entities to assure they are following NCQA and CMS guidelines.
    8. Site and desktop audits of the Provider Organizations Policies and Procedures, ensuring compliance with accrediting organization requirements.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Consultant
Education
Education
Diploma


Sr. Credentialing Coordinator Resume

Summary : To obtain a position where I can utilize and enhance my experience in provider credentialing and customer service roles. Outstanding team player recognized for introducing effective methods to increase productivity within the department.

Skills : Training, Customer Service, Staff Training And Development, Project Leadership, Claims Operations,Provider Credentialing.

Description :

    1. Prepares, disseminates, collects, reviews and processes applications for appointment and reappointment, and accompanying documents, ensuring applicant eligibility.
    2. Conducts through background investigation, research and primary source verification of all components of the application file, including retrieval of National Practitioner Database.
    3. Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow-up and closure.
    4. Prepares and completes credentialing files for review by the appropriate department chair and presentation at relevant Credentialing Committee, ensuring file completion within time periods specified.
    5. Reviews and processes request for change in privileges, ensuring compliance with the Medical Staff Bylaws, Credentials Policy, and criteria outlined in clinical privilege descriptions.
    6. Responds to inquiries from other healthcare organizations, interfaces with internal and external customer on day-to-day credentialing and privileging issues as they arise.
    7. Assists with credentialing audits by internal and external surveyors.
    8. Utilizes the credentialing database, optimizing efficiency and performs data entry, query, report and document generation.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Accounting

Jr. Credentialing Coordinator Resume

Summary : Reliable and highly skilled Credentialing Coordinator with deep knowledge of healthcare and credentialing standards. Excellent communication skills with providers and office staff, hospital medical staff offices and auditors. Able to function well independently or as part of a team.

Skills : Word, Exel, MD Staff & Morrisey.

Description :

    1. Performed initial provider credentialing and re-credentialing for direct contract and physician groups managed by the MSO.
    2. Communicated with and maintained healthy relationships with physicians, office personnel, Health plans, hospitals and IPA provider relations departments to acquire primary source verification and provide and/or obtain documentation pertinent to the timely and accurate completion of the credentialing process.
    3. Performed on-going monitoring, audit preparation and credentialing committee preparation and Reporting.
    4. Maintained productive, professional relationships with all levels of staff, Providing Administrative and clerical support as required.
    5. Ability to function in a demanding environment by navigating multiple projects simultaneously and effectively.
    6. Responsible for all data-entry, including provider additions and terminations, demographic Changes as well as tax-id and billing information changes.
    7. Microsoft and Cactus Credentialing software proficient.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Marketing

Credentialing Coordinator III Resume

Summary : Seeking a challenging position with a progressive company allowing for professional and personal growth. Combined professional experience within the healthcare industry includes an emphasis in credentialing and privileging.

Skills : IntelliApp, MD Staff, Visio, MS Office Suite, Lotus Notes, Microsoft, Priv+ Credentialing Software.

Description :

    1. Coordinate and facilitate all aspects of external and internal credentialing and privileging for National Jewish Health faculty and contracted physicians through the initial and reappointment processes.
    2. Research, verify, and provide analysis of completed applications and credentials files.
    3. Investigate and resolve credentialing or privileging issues by obtaining appropriate follow-up documentation and report all identified issues to the Manager of Medical Staff Services.
    4. Maintain the integrity of regulatory requirements and processes as outlined in Medical Staff governance documents, hospital policies, Joint Commission standards, NCQA standards, and State and Federal laws.
    5. Maintains a current knowledge of legal issues and regulatory requirements which impact Medical Staff credentialing.
    6. Develop and maintain current, accurate, and confidential credential files for each Medical Staff member.
    7. Handle and assure the confidentiality of sensitive information about Medical Staff and Allied Professional Staff members including: peer review, performance improvement, and medico-legal issues as well as hospital performance.
    8. Assure the accuracy and integrity of the Medical Staff Services office database.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Consultant
Education
Education
Business Administration

Credentialing Coordinator II Resume

Headline : Self-motivated individual with excellent computer software and customer service experience 70 wpm Ability to multi-task and work in a fast-paced environment Experienced in Word, Excel, Access, Outlook and PowerPoint Skilled at learning new concepts quickly, working well under pressure, and communicating ideas clearly and effectively Attentive to detail Interpersonal communication skills.

Skills : Microsoft Office Including Word, Excel, Outlook, Power Point & Quick Books, Windows; Adobe Illustrator; Win Zip, Inter-net, Apogee, PowerStepp, Adobe Acrobat, MDStaff, Morrisey,.

Description :

    1. Responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process.
    2. Facilitates all aspects of DHHA credentialing, including initial appointment, reappointment, expirables process, as well as clinical privileging for Medical Staff, Allied Health Professionals, and all other providers outlined in the DHHA Medical Staff Bylaws, policies, or related contracts.
    3. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing.
    4. Responsible for the accuracy and integrity of the credentialing database system and related applications.
    5. Works under the supervision of the Credentialing Manager.
    6. Duties and Responsibilities Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
    7. Conducts thorough background investigation, research and primary source verification of all components of the application file.
    8. Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
Business

Credentialing Coordinator I Resume

Objective : Skilled Administrative professional with over 20 years of administrative and leadership experience in the medical staffing field. Experienced at providing superb customer care in hectic situations, working in a team or individually to achieve results, and management of a diverse team. Seeking to maximize skill sets at a dynamic organization with the ability to learn and grow successful.

Skills : Microsoft Office, Photoshop, Social Media, French, POS, Microsoft Word, Microsoft Excel, Microsoft PowerPoint, Customer Service, Telephone Skills, Cash Register, Cash Handling, POS, Google Docs, Basic Computer Skills.

Description :

    1. Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring physician and mid-level eligibility.
    2. Conducts thorough background investigation, research and primary source verification of all components of the application file.
    3. Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
    4. Prepares credentials file for completion and presentation to Health System Entity Medical Staff Committees, ensuring file completion within time periods specified.
    5. Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
    6. Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
    7. Assists with managed care delegated credentialing audits; conducts internal file audits.
    8. Utilizes the Cactus credentialing database, optimizing efficiency, and performs query, report and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act.
Years of Experience
Experience
0-2 Years
Experience Level
Level
Entry Level
Education
Education
Business

Lead Credentialing Coordinator Resume

Summary : A Seasoned, result driven, business and healthcare professional with over 5 years of progressive experience in various roles & responsibilities in a CBO setting. A business office professional with a strong attention to details, ability to multitask, and the capacity to perform well under high stress. Adapts to ever-changing healthcare landscape, pro-active, organized, and customer-focused. Proven track record of successfully leading and managing billing, collections, and improving revenue cycle workflows especially in the addiction & mental health field.

Skills : Theracall, Windows, Excel, Outlook, Micro Soft Word, Teamtrack, FACETS.

Description :

    1. Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
    2. Conducted a thorough background investigation, research and primary source verification of all components of the application file.
    3. Identified issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
    4. Prepared credentials file for completion and presentation to Health System Entity Medical Staff Committees, ensuring file completion within time periods specified.
    5. Processed requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
    6. Responded to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
    7. Assisted with managed care delegated credentialing audits; conducts internal file audits.
    8. Utilized the Cactus credentialing database, optimizing efficiency, and performs query, report and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
MS

Asst. Credentialing Coordinator Resume

Summary : To obtain a position with a company that allows me to utilize my drive to improve company volume and profit growth.

Skills : 10 years of experience providing customer support in.

Description :

    1. Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
    2. Conducts thorough background investigation, research and primary source verification of all components of the application file.
    3. Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
    4. Prepares credentials files for completions and presentation to Health System Entity Medical Staff Committees, ensuring file completion within time periods specified.
    5. Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
    6. Responds to inquiries from other healthcare organization, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
    7. Assist with managed care delegated credentialing audits: conducts internal file audits.
    8. Utilizes the Cactus Credentialing database, optimizing efficiency, and performs query, report and documents generation: submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
BS In Management

Associate Credentialing Coordinator Resume

Objective : Business professional efficient and reliable with project management skills, nine+ years of healthcare experience and education. Very detailed and a passionate person with goals to improve the healthcare and grow with the changing industry. Skilled in all of the standard office desktop software, diversified skill sets covering client relations, writing, database management and project management. Excellent inter-personal, phone and digital communication skills.

Skills : Healthplan Enrollment, Health Insurance Denials, Prior Authorizations, Health Plan Contracting.

Description :

    1. Coordinates appointments and reappointments and clinical provider application packets in a timely, efficient manner and communicates provider credentialing status as appropriate.
    2. Researches and effectively utilizes all available credentialing resources to ensure appropriate privilege delineation forms for all specialties.
    3. Communicates with hospitals, payers, providers and other entities in an effort to quickly and accurately obtain or provide information beneficial to the effective credentialing or enrollment need.
    4. Responsible for timely response of the athena E.H.R Enrollment Services Dashboard tasks and overall maintenance and content.
    5. Coordinates with Business Office by researching and correcting claim issues within athenaNet involving the facility and provider denials, taxonomy, NPI, claim population, and enrollment.
    6. Administrator of the health plan portals for the Business office, Registration, and Medical records for access to eligibility, claims, referrals, and prior authorizations.
    7. Coordinates and participates in biannual credentialing file audits.
    8. Creates and maintains practitioner files in an organized, efficient and confidential manner.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Bachelor's In Business

Credentialing Coordinator Head Resume

Headline : Responsible for the credentialing of all new physicians and nurse practitioners. I also re-credential 80 + physicians. Interested in being an independent credentialing consultant.

Skills : Microsoft Office, ADP, Kronos, Ceridian, Ceridian, Excel, Word, Powerpoint.

Description :

    1. Performed daily functions of the credentialing and re-credentialing process by processing applications for Physicians, Renal Fellows, and Allied Health Professionals.
    2. Credentials providers according to all Credentialing Policies and Procedures, Medical Staff Bylaws Rules and Regulations and Federal and State regulatory requirements.
    3. Worked with various departments and clinic personnel as a resource and to ensure timely credentialing.
    4. Responsible for processing a high volume of privilege requests from: Physicians, Renal Fellows, Nurse Practitioners, Physician Assistants, and Clinical Nurse Specialists.
    5. Reviewed and tracked requests to add/remove practitioners to facilities in assigned divisions.
    6. Sent link and passwords to access application materials, reviewed returned applications for completeness, followed up on any outstanding information or additional information needed, and performed primary source verifications.
    7. Followed up with non-responsive practitioners and assisted with obtaining credentialing packets and other documentation.
    8. Entered and updated practitioner information in the credentialing database maintaining data integrity standards.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
Bachelor Of Science

Credentialing Coordinator Resume

Headline : Excellent organizational and communication skills Proficient in the use of Microsoft Office, internet research, Medical Staff databases and related programs Self-starter with an ability to work effectively in a high-pressure environment Experienced background in the healthcare and professional setting Strong work ethic, conscientious, committed, team player.

Skills : Credentialing, Word Processing, Proofreading, Typing.

Description :

    1. Coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
    2. Conducts thorough background investigation, research and primary source verification of all components of the application file.
    3. Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
    4. Prepares credentials file for completion and presentation to Medical Staff Committee, ensuring file completion within time periods specified.
    5. Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
    6. Responds to inquiries from providers, interfaces with internal and external Staff/Providers on day-to-day credentialing and privileging issues as they arise.
    7. Assists with managed care delegated credentialing audits; conducts internal file audits.
    8. Utilizes the Morrisey credentialing database, optimizing efficiency, and performs query, report and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
MS