Credentialing Manager Resume Samples

The basic job duty of a Credentialing Manager is to manage the staff that process and handle credentialing and re-credentialing applications for the medical providers. A well-drafted Credentialing Manager Resume mentions the following duties and tasks – implementing policies and procedures to ensure the applications are properly verified and uploaded accurately into the database; presenting files to the credentialing committee; acting as a liaison to the state medical licensure board, preparing reports on trends, advising on all current personnel; and overseeing the maintenance and upkeep of such certifications.

Those seeking this job should highlight the resume with such skills and abilities as – the ability to make administrative and procedural decisions and judgments; knowledge of medical credentialing and privileging procedures and standards; proficiency in preparing budgets; and knowledge of medical staff policies and regulations. While some prefer a degree qualification, many want to see on the resume a necessary certification in the area of work.

Credentialing Manager Resume example

Credentialing Manager Resume

Headline : Twenty three years of progressive experience within multiple lines of business throughout the Human Resource and Healthcare industries. Proven ability to exceed production goals by building and mentoring teams through effective managing and training.

Skills : Microsoft Office, Medical Billing, Medical Records, Credentialing, Customer Relations, Public Speaking.

Description :

    1. Lead, developed and trained all internal employees and responsible for all the human resources activities within the branch as dictated by company standards.
    2. Responsible for maintaining compliance of all external employee personnel records.
    3. Assisted candidates through the application process.
    4. Processed all workmen's compensation claims for the office.
    5. Completed reference checks on all applicants being considered for employment.
    6. Processed the criminal history record search through the appropriate Consumer Reporting Agency (or state criminal records repository, if applicable).
    7. Ensured that applicants are notified of scheduled for orientation within three working days of application.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
AAS


Sr. Credentialing Manager Resume

Summary : 22-year Progressive and Productive Healthcare Career working with Managed Care, Account Leadership, Solid Revenue Growth, Solid Internal & External Customer Relations, Strong Organizational and Communication Skills, Exceptional ability to Multitask. Strong background in CPT & ICD-9 coding, Medical and Remote Insurance Billing, HIPAA Certified & Compliant.

Skills : Excel Sheets And Word 2013, Advanced MD Medical Software, Lytec Software, Practice Point Manager 6.5, Medical Manager, Next Gen Medical Software.

Description :

    1. Negotiated all contracts from Ins payers.
    2. Reviewed all applications are accuracy.
    3. Coordinated, developed monitored, and maintained the credentialing process.
    4. Updated and maintained all applicable provider numbers in the system database.
    5. Maintained a network of relationships with third party and government payors and the regional sales staff located nationwide.
    6. Ensured that all licensure, certifications and accreditations processes and procedures were completed and maintained in accordance with established regulatory, compliance and policy requirements for all 50 states.
    7. Prepared electronic submissions and remittances with all contracted and non-contracted payors.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Accounting


Jr. Credentialing Manager Resume

Objective : An experienced credentialing professional with strong communication, organizational, and problem-solving skills.

Skills : Medical Staff Credentialing.

Description :

    1. Responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process.
    2. Facilitated all aspects of credentialing, including initial appointment, reappointment, the expirables process, and clinical privileging for Medical Staff and Allied Health Professionals.
    3. Established a timely appointment and reappointment process.
    4. Developed privilege criteria, privilege delineations, and other documents necessary for an effective credentialing process.
    5. Worked with the Medical Staff to facilitate development of competency criteria for individual clinical privileges.
    6. Responsible for managing, coordinating, and monitoring the Medical Staff Services functions.
    7. Collaborated and coordinated with Medical Staff leaders and administrative representatives.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Bachelor Of Science

Credentialing Manager III Resume

Summary : Secure an Account Credentialing Manager position where will be an asset making a significant contribution to employer due to training, file management and leadership skills. Desire a role that will afford both professional and personal growth while utilizing knowledge and background.

Skills : Microsoft, Medical Credentialing, Medical Billing, Law Enforcement.

Description :

    1. Provided ongoing motivation, counseling, feedback, new client information/changes, system enhancements and updates to team associates in a timely manner.
    2. Monitored all Work in Process reports to ensure profile delivery consistent with agreed-upon timelines per client agreement.
    3. Acted as first point of escalation for practitioner/office complaints.
    4. Reported and resolved complaints per company policy.
    5. Provide Wiki (client specific requirements) updates to QI Department per company policy.
    6. Monitored active CVOne users.
    7. Participated in preparation for file/quality audits from clients and external accrediting bodies.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
History

Credentialing Manager II Resume

Summary : Credentialing professional with extensive experience in delivering positive results in support of various State Regulations, NCQA and JCAHO requirements. Areas of expertise include: Productivity Management Quality Assurance Policy Implementation Exceptional Problem Solving Customer Interaction Skills Project Management Presentation Skills Team Motivating Activities.

Skills : NAMSS Credentialing Provider Credentialing Specialist.

Description :

    1. Managed the operations for a 9 facility system credentialing office with a staff of 8 and medical/allied health staff size of 4200.
    2. Ensured that initial appointment specialist complete faculty credentialing applications in less than 90 days which facilitates the enrollment of the physicians into the government payer plans and 120 managed care plans for which Emory has delegated agreements.
    3. Ensured that reappointment specialists complete applications 2 months prior to the expiration of the current appointment to ensure that if any adverse actions are found, files can be presented to the Governing Board as they only meet every other month.
    4. Conducted manual and virtual audits of applicant records to ensure that all specialists have obtained all required documents in accordance with each hospitals bylaws requirements.
    5. Reviewed malpractice claims issues for proper escalations to ensure that chairs and chief have an opportunity to review and make recommendations on applicants with adverse issues.
    6. Created and revised credentialing procedures and manual.
    7. Trained experienced and non-experienced staff in the field of credentialing for the purpose ensure regulatory compliance.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
High School

Credentialing Manager I Resume

Objective : Over Twenty years' experience in a credentialing environment. Ability to provide suggestions for improvements and leadership initiatives. Organizational skills and timely assignment completion of daily work and/or any assigned projects. Knowledge and understanding of NCQA/CVO/MCO/URAC guidelines and standards.

Skills : Management, Customer Service, Credentialing, Facilities Management, Process Improvement.

Description :

    1. Performed process and procedural audits of all revenue cycle functions for Calnet membership which consists of approx.
    2. Worked within the Managed Care System to ensure contract payment compliance.
    3. Interpreted, analyzed and model managed care and commercial contracts.
    4. Interacted with internal and external customers and ensure value is delivered and customer satisfaction is achieved.
    5. Assisted in the improvement of internal business processes and in meeting future reimbursement service needs.
    6. Developed process improvement projects, i.e.
    7. review and analyze physician and payer information to identify and analyze trends that may affect the ability of Calnet membership to collect for the services provided.
    8. Maintained performance data using spreadsheet and database applications.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
BA In English

Assistant Credentialing Manager Resume

Summary : To gain advanced opportunities and professional development in a dynamic environment. Core Qualifications Over five years background in effective business and healthcare administration, organizational and project management skills. Two Years Managerial experience to a team of nine associates. Knowledge of analytical reporting using advanced Excel and Access features including pivot tables, Queries and charts.

Skills :  Excel, Power Point, Publisher, Adobe.

Description :

    1. Worked collaboratively with 15 Health plans from different states to process provider applications timly and accurately.
    2. Managed daily inventory to assure all timelines, and work processes are met.
    3. Performed Monthly Quality reviews to assure accuracy of data, and compliance to all NCQA, State and company guidelines.
    4. Provided guidance, assistance, and direction in the Credentialing process to Providers, team members, and Health Plans.
    5. Implemented and oversaw adherence to Credentialing policies and procedures.
    6. Created and Maintained tools to assist team members, Management, Health plans, and other counterparts in deciphering requirements needed per State per Provider type.
    7. Mentored and assisted in training and with startups for new Credentialing Specialist and temporary employees.
    8. Able to meet time-sensitive deadlines and multi-task in a changing environment.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Computer Science

Associate Credentialing Manager Resume

Objective : To acquire a challenging and rewarding career that will enable to utilize skills, abilities and past experience to make an invaluable contribution to any company.

Skills : Microsoft Word, Excel, Power Point, Publisher, Adobe, Google Apps And Google Drive.

Description :

    1. Supervised an office of credentialing specialists assisting physicians with registration and license renewal; verify qualifications are met, correct problems, correspond with clients, respond to inquiries, and ensure all applications are complete, issue payment, and submit to approving body.
    2. Processed DEA reappointment application for physicians.
    3. Reviewed initial appointment applications and supplemental documents for completeness on behalf of twenty-one hospitals.
    4. Completed primary source verification for initial and re-appointments.
    5. Reviewed applications and supporting documents for renewal of physician hospital privileges.
    6. Met with the Joint Commission to provide documentation for on-site visits.
    7. Tracked billing hours and submit invoices to clients.
    8. Maintained files and ensure all records are accounted for, current, and up to date.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
Certificate

Assistant Credentialing Manager I Resume

Headline : Proven success working with colleagues, supervisors and clients or students. Able to collaborate with groups and foster team work. Experience in dealing with difficult people and managing conflict. Attention to detail is superb. Outstanding organizational skills. Personnel and program management experience. Well-rounded individual. High energy and high efficiency. Positive, effective leadership style.

Skills : Microsoft Office, Adobe, Many Payroll And Adminstrative Systems., Managing People, Higher Education.

Description :

    1. Assured the organization and staff fulfill credentialing requirements.
    2. Monitored provider staff licensure and intercede when necessary.
    3. Developed center guidelines and policies regarding credentialing.
    4. Determined return on investment and verification of information for third party insurance companies.
    5. Interfaced with clinical services, human resources, billing, business development and accounts receivable.
    6. Researched and created new business with third party insurance companies in Pueblo, Las Animas and Huerfano counties.
    7. Provided weekly reports of status of licensure and privileging for all new hire hospitalists.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
Business Administration

Credentialing Manager Resume

Summary : Credentialing professional with extensive experience in delivering positive results in support of various State Regulations, NCQA and JCAHO requirements. Areas of expertise include Productivity Management Quality Assurance Policy Implementation Exceptional Problem Solving Customer Interaction Skills Project Management Presentation Skills Team Motivating Activities.

Skills : NAMSS Credentialing Provider Credentialing Specialist.

Description :

    1. Managed the operations for a 9 facility system credentialing office with a staff of 8 and medical/allied health staff size of 4200.
    2. Ensured that initial appointment specialist complete faculty credentialing applications in less than 90 days which facilitates the enrollment of the physicians into the government payer plans and 120 managed care plans for which Emory has delegated agreements.
    3. Ensured that reappointment specialists complete applications 2 months prior to the expiration of the current appointment to ensure that if any adverse actions are found, files can be presented to the Governing Board as they only meet every other month.
    4. Conducted manual and virtual audits of applicant records to ensure that all specialists have obtained all required documents in accordance with each hospitals bylaws requirements.
    5. Reviewed malpractice claims issues for proper escalations to ensure that chairs and chief have an opportunity to review and make recommendations on applicants with adverse issues.
    6. Created and revised credentialing procedures and manual.
    7. Trained experienced and non-experienced staff in the field of credentialing for the purpose ensure regulatory compliance.
    8. Addressed emergent department issues such as needing to hire a mid-level outside of the normal 90 day turnaround window required and ensuring that files are completed in order to grant temporarily privileges to ensure patient care is not interrupted at any time.
    9. Participated in Managed Care, Joint Commission and State audits on a regular basis.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
High School