Description :

1. Conducted thorough analysis and verification of immunizations and training certifications to ensure compliance.
2. Managed multiple credentialing queues, including TB and drug screening documentation.
3. Provided training to colleagues on corporate accounts and compliance standards.
4. Fostered relationships with account managers to streamline the credentialing process.
5. Maintained accurate documentation during peak seasons through effective multitasking.
6. Processed and managed documentation within a 24-72 hour timeframe.
7. Led corporate training initiatives, enhancing employee understanding of credentialing requirements.

Experience

0-2 Years

Level

Entry Level

Education

B.S. H.A.

Description :

1. Oversee the complete credentialing and recredentialing process, ensuring data integrity across multiple systems for healthcare providers and allied health professionals.
2. Ensure compliance with regulatory and accreditation standards by interpreting relevant laws and guidelines effectively.
3. Maintain accurate provider data using CAQH and other credentialing applications, facilitating timely provider onboarding.
4. Monitor and manage credentialing applications, ensuring thorough follow-up and timely resolution of issues.
5. Maintain up-to-date knowledge of health plan requirements and manage corporate provider contract files accordingly.
6. Establish and maintain provider information in credentialing databases, including Cactus, OmniFlow, and Xcelys, ensuring accuracy and accessibility.
7. Collaborate with cross-functional teams to enhance credentialing processes and resolve discrepancies efficiently.

Experience

5-7 Years

Level

Senior

Education

B.S. HCA

Description :

1. Facilitated the credentialing and recredentialing of healthcare providers, ensuring timely and compliant submissions.
2. Coordinated application processes in collaboration with reimbursement specialists to enhance efficiency.
3. Updated insurers on provider participation changes, ensuring accurate records and compliance.
4. Acted as a liaison between providers and insurers, resolving application inquiries efficiently.
5. Maintained detailed physician files, ensuring all documentation was current and accurate.
6. Managed a comprehensive database of credentialing information to support audits and reporting.
7. Engaged with physicians daily to address concerns and promote positive relationships.

Experience

7-10 Years

Level

Management

Education

B.S. Health Admin.

Description :

1. Oversee the credentialing process for approximately 275 new residents and fellows annually, ensuring timely onboarding.
2. Manage ongoing services for around 1,400 residents and fellows, maintaining compliance with licensing requirements.
3. Process Visa applications and verify National Practitioner Data Bank (NPDB) licensure.
4. Conduct background checks and log drug screening results to uphold safety standards.
5. Act as a liaison between residents/fellows and the Benefits and Payroll departments for direct deposit setups.
6. Facilitate recertification of ACLS and BLS for staff, coordinating with Learning Network and House Staff officers.
7. Prepare documentation and generate contracts for residents, ensuring accuracy and compliance.

Experience

5-7 Years

Level

Management

Education

B.S. in HA

Description :

1. Managed the accurate entry and maintenance of data in credentialing databases, preparing reports for the Medical Management Committee.
2. Communicated regularly with providers to update them on credentialing status, ensuring timely follow-ups for missing information.
3. Built and maintained strong professional relationships with healthcare providers and internal teams.
4. Collaborated with multiple departments to meet client service obligations as per contract agreements.
5. Identified opportunities for process improvements and presented recommendations to the Compliance Manager.
6. Maintained thorough knowledge of credentialing operations and regulatory requirements.

Experience

0-2 Years

Level

Entry Level

Education

B.S. HIM

Description :

1. Responsible for processing provider applications, credentialing, re-credentialing, and primary source verification for Commercial Tricare accounts.
2. Conduct audits to ensure timely and accurate credentialing of all providers.
3. Review systems to assess provider network status and compliance.
4. Engage with providers for missing information via phone, fax, or letter.
5. Input and maintain provider credentialing data in the Vistar system.
6. Collaborate with PSV Coordinator to establish verification resources, including NPDB and criminal background checks.
7. Managed provider credentialing processes to ensure compliance with regulatory standards.

Experience

2-5 Years

Level

Junior

Education

B.S. in HA

Description :

1. Acted as the primary point of contact for credentialing within the Texas Army National Guard, ensuring regulatory compliance.
2. Managed provider files in strict accordance with Army regulations and HIPAA standards.
3. Advised on adverse actions against non-compliant providers to the State Army Surgeon.
4. Coordinated and facilitated credentialing boards for provider privileging.
5. Engaged with providers to support mission readiness and compliance.
6. Maintained and updated a database tracking certifications and training for over 200 Healthcare Specialists.
7. Ensured compliance in medical records management, including electronic filing and HIPAA adherence.

Experience

7-10 Years

Level

Management

Education

B.S. Health Admin.

Description :

1. Facilitated credentialing workflows for healthcare practitioners, ensuring timely processing and compliance with regulations.
2. Represented the department in committee meetings, advocating for best practices in credentialing.
3. Served as a liaison between healthcare providers, insurance plans, and facilities to streamline communication.
4. Reviewed and processed credentialing applications, maintaining confidentiality and accuracy of sensitive information.
5. Communicated directly with medical practitioners to clarify documentation requirements and expedite applications.
6. Maintained provider data in online credentialing databases, ensuring real-time accuracy and accessibility.
7. Tracked and managed certification and licensure expirations to facilitate timely renewals.

Experience

2-5 Years

Level

Executive

Education

B.S. in HA

Description :

1. Manage the credentialing and re-credentialing process for Medical and Allied Health Professionals, ensuring accuracy and regulatory compliance.
2. Conduct primary source verification for providers per NCQA standards and relevant regulations.
3. Monitor and maintain current licenses, DEA, and malpractice coverage for all credentialed providers.
4. Generate and analyze credentialing reports utilizing Cactus and QNXT software.
5. Input and update provider information in CAQH, ensuring data integrity and compliance.
6. Research potential sanctions and prepare reports for the Credentialing Committee review.
7. Perform administrative support tasks, including correspondence management and documentation filing.

Experience

5-7 Years

Level

Senior

Education

B.S. Health Admin

Description :

1. Reviewed and verified provider documentation to ensure compliance with credentialing standards.
2. Coordinated the credentialing and re-credentialing processes, managing all necessary documentation.
3. Maintained comprehensive provider files, including licenses, certifications, and insurance information.
4. Acted as a liaison between providers and internal departments to facilitate information exchange.
5. Ensured accuracy and completeness of applications before submission to management and committees.
6. Communicated credentialing status updates to providers and stakeholders efficiently.
7. Managed incoming applications, ensuring timely processing and adherence to deadlines.

Experience

7-10 Years

Level

Executive

Education

B.S. in HA

Description :

1. Ensured timely re-credentialing of providers to maintain compliance.
2. Performed verification of provider credentials, including licenses, medical education, and residency training.
3. Established and maintained provider files in compliance with client specifications.
4. Coordinated credentialing for physicians through written source verification.
5. Ensured up-to-date documentation for each physician's credentials.
6. Assisted physicians in acquiring state-specific medical licenses.
7. Processed privileging applications for locum tenens assignments efficiently.

Experience

0-2 Years

Level

Entry Level

Education

B.S. in HA

Description :

1. Served as the primary liaison between healthcare providers, human resources, and insurance companies to facilitate credentialing processes.
2. Executed thorough reference checks and primary source verifications for licenses and certifications across 19 states.
3. Managed the credentialing process for employment and insurance providers, ensuring compliance with state regulations.
4. Obtained CLIA certificates for clinics, ensuring timely operations and compliance.
5. Generated weekly credentialing reports for management to assess newly hired healthcare professionals' status.
6. Resolved discrepancies in provider applications and documentation.
7. Proactively notified staff of expiring licenses and certifications to maintain compliance with credentialing policies.

Experience

0-2 Years

Level

Entry Level

Education

BSHA

Description :

1. Assisted in analyzing and implementing the Credential Review Privilege Program for healthcare providers.
2. Gathered, verified, and analyzed medical education and specialized training of practitioners requesting hospital privileges.
3. Supported over 280 current trainees and managed hundreds of training verification requests annually.
4. Coordinated verification processes with agencies both domestically and internationally.
5. Reviewed contractor qualifications, ensuring all education, training, and licenses met standards for prospective employees.
6. Verified background information to establish provider expertise in the medical field.
7. Researched and prepared detailed reports for individual credential files.

Experience

2-5 Years

Level

Junior

Education

BSHA

Description :

1. Re-credentialed over 200 physicians and allied health professionals for 29 facilities, enhancing compliance and operational efficiency.
2. Processed and analyzed extensive verification and accreditation data, including applications, education, and licensure information.
3. Generated monthly reports on expirations of licenses and certifications, ensuring timely renewals.
4. Maintained effective communication with practitioners to keep records accurate and current.
5. Coordinated with Medical Staff Offices to gather necessary documentation for credentialing.
6. Collaborated with Finance to ensure timely processing of re-credentialing fees.
7. Conducted internal audits of provider files to uphold legal documentation standards and confidentiality.

Experience

2-5 Years

Level

Executive

Education

AAS-HIT

Description :

1. Received and processed therapist application requests for group inclusion, ensuring prompt verification of qualifications.
2. Communicated necessary documents and missing data to therapists and program directors to facilitate efficient credentialing.
3. Utilized insurance websites to initiate credentialing contracts, enhancing the onboarding process for new providers.
4. Managed the annual re-validation of facility location data, maintaining compliance with regulatory standards.
5. Confirmed therapist credentials upon request from insurance companies, ensuring accurate provider information.
6. Contacted insurance companies to verify Medicare, Medicaid, and commercial insurance benefits for patients.
7. Documented and maintained accurate comprehensive data for billing and claims, improving operational efficiency.

Experience

10+ Years

Level

Senior

Education

BSHSA

Description :

1. Managed the end-to-end credentialing process for healthcare providers, ensuring compliance with NCQA and JCAHO standards.
2. Utilized Oracle software to accurately place providers on appropriate plans.
3. Oversaw credentialing for the entire Medical Staff, maintaining up-to-date records.
4. Conducted regular audits to ensure adherence to industry standards and regulations.
5. Facilitated communication with providers to resolve credentialing inquiries and issues.
6. Identified areas for operational improvement and proposed actionable solutions to senior management.
7. Maintained strong relationships with clients to support enrollment and retention initiatives.

Experience

2-5 Years

Level

Junior

Education

B.S. Health Admin.

Description :

1. Initialized and maintained credentialing procedures for new healthcare providers.
2. Communicated effectively with insurance companies to establish provider networks and maintain fee schedules.
3. Coordinated credentialing processes for new clients in the membership department.
4. Managed the re-credentialing process, ensuring compliance with primary source verification.
5. Reviewed and updated credentialing files for accuracy and completeness.
6. Conducted primary source verifications and compliance reviews.
7. Monitored community development activities to ensure adherence to program requirements.

Experience

2-5 Years

Level

Junior

Education

B.S. in HA

Description :

1. Developed relationships with state licensing boards and professional organizations.
2. Ensured timely processing of applications to minimize delays.
3. Maintained demographic logs for twelve providers, ensuring accurate healthcare network statuses.
4. Completed healthcare contracts for providers to participate in various health networks.
5. Enrolled providers in different healthcare options, including HMO and PPO.
6. Created National Provider Identifiers and completed CAQH applications.
7. Managed and updated provider records in the Consolidated Provider File database.

Experience

0-2 Years

Level

Entry Level

Education

ASHS

Description :

1. Collaborated with vendors to streamline credentialing processes.
2. Verified professional credentials to ensure compliance with industry standards.
3. Provided exceptional customer service to providers and stakeholders.
4. Created and maintained a comprehensive database for professional credentials.
5. Responded to inquiries regarding credentialing status and processes.
6. Conducted regular audits to maintain data accuracy in the credential database.
7. Updated and researched credential information as required.

Experience

0-2 Years

Level

Entry Level

Education

B.S. in HA

Description :

1. Collaborated with cross-functional teams to ensure accurate credentialing data.
2. Maintained comprehensive records of provider compliance with credentialing requirements.
3. Created detailed documentation outlining credentialing processes for team reference.
4. Managed the company's onsite verification program to enhance accuracy.
5. Coordinated registration for industry events and ensured all credentialing information was submitted.
6. Maintained an organized database of events and credentialing programs.
7. Communicated updates and changes to credentialing policies to relevant stakeholders.

Experience

0-2 Years

Level

Fresher

Education

B.S. in HA