A Credentialing Supervisor verified the professional licenses and certifications of the medical staff. The job description entails making sure the state and federal standards are followed and assisting auditors in keeping the facility’s accreditation. Essential roles and responsibilities are outlined on the Credentialing Supervisor Resume as – verifying healthcare credentials; ensuring all licenses and credentials are verified and updates, conducting background checks, and reviewing license applications; reviewing applications and resumes, assessing facility practices, and reviewing the ways in which the services are being handled, and maintaining the database by regularly updating the same.
The strongest resume emphasizes health information expertise, communication skills, teamwork, attention to detail, and organizational skills. Other crucial skills are – staying aware of medical licensing and certifications; a good understanding of current healthcare laws and regulations, and researching skills. Most positions need an associate’s degree in health informatics or health information management.
Objective : As a Credentialing Supervisor, responsible for Ensuring you have all necessary documents available when starting the application process, reviewing the additional job description section on postings for documents that may be required.
Skills : Managing Skills, Supervising Skills.
Description :
Managed staff(6) and daily work flow.
Employeed questions and comments.
Address questions or issues from Management.
Coordinated monthly activities.
Oversaw of delegated groups and external contracts.
Downsized network to 44,000 providers nationwide- stop PPO line of business.
Oversaw Credentialing Committee and communications.
Experience
2-5 Years
Level
Executive
Education
MS
Credentialing Supervisor Resume
Objective : As a Credentialing Supervisor, responsible for communicating effectively with all levels of management, clinical departments, and physicians, working with minimal supervision and to maintain confidentiality due to access to sensitive information.
Skills : Microsoft Excel, Data Entry, Computer.
Description :
Performed any additional duties as requested by management within the scope of knowledge.
Performed the maintenance of the matrix of the credentialing department.
Performed in company wide Kaizen: Which is a Japanese business philosophy of continuous improvement of working practices, personal efficiency, etc.
Researched, reviewed and updated current credentialing policies and procedures as needed to comply with provider or state requirements related to background searches or documentation requirements.
Assisted management with audits as required by provider health plan's policies as needed.
Supervised 8 credentialing coordinators.
Conducted performance appraisals and reviews.
Experience
2-5 Years
Level
Executive
Education
High School Diploma
Credentialing Supervisor Resume
Objective : Experienced credentialing supervisor with diverse knowledge in handling administrative/managerial tasks. Seeking a position in the Healthcare Industry to achieve a comfortable working environment with excellent customer satisfaction and quality that exceeds the standards set for the department and/or company.
Skills : QuickBooks, Excel, Outlook, EMR: gastro/GMED, Practice Management: Medical Manager, Intergy, Athena, Charge Capture Software: PMD Soft, Internet; Fluent in both English and Spanish.
Description :
Ensured NCQA policies/procedures compliance in all states by verifying provider credentials.
Established metrics by analyzing and tracking individual / departmental production using Excel.
Strengthened team by overseeing and conducting interviewing and hiring activities.
Completed physician, nurse and other employee verifications and ensures that the organization and staff are in accordance with staff by-laws, industry trends, and standard credentialing procedures.
Responsible for monitoring the verification process for medical staff (Ancillary, PCP's and Specialists) Provide oversight and guidance to the Credentialing team to assure all timelines, accuracy of data and work processes are met.
Assured all federal and state reporting requirements are met.
Developed and implemented standards to ensure the accuracy of provider credentialing.
Experience
2-5 Years
Level
Executive
Education
High School Diploma
Credentialing Supervisor Resume
Headline : Looking for a position that will allow me to utilize ten years of combined experience in credentialing, management, and health care administration. I would like to continue to gain experience that will enhance my knowledge base, while furthering my education in the health care field. I hope to gain a better understanding of the changing healthcare landscape in order to make a thriving contribution to the field.
Skills : Financial Management - Budgets And Expenditures, HR.
Description :
Responsible for the overall management of the Credentialing Department.
Managed the credentialing process of over 3,000 par Providers.
Ensured Providers were credentialed and re-credentialed within mandated time period.
Implemented submission of applications through CAQH system as opposed to paper submission - significantly reducing error rate, improving work flow and decreasing turn-around time for processing applications.
Spearheaded the scanning of all paper records to electronic version utilizing DocStar scanning system.
Delineated the responsibility of continual license verification tasks and developed automated letters to Providers due for re-licensing.
Recruited, trained, and supervised credentialing staff; streamlined operations and implemented strategies to improve health plan's credentialing program.
Experience
5-7 Years
Level
Executive
Education
Masters In Healthcare Administration
Credentialing Supervisor Resume
Headline : To seek a career path in an organization offering continuous growth and opportunity to utilize my management, organizational, technical, and training skills.
Skills : English & Spanish, Maintenance Skills.
Description :
Provided daily oversight, direction, support and leadership to credentialing team Specialized in credentialing initial and re-credentialing applications for healthcare professionals such as M.D.'s, D.O.'s, DME's and Allied Health Professionals nationwide.
Received and reviewed documents necessary for credentialing from new providers and entered it into database management.
Assembled files and assigned them to credentialing team members for processing; while keeping maintenance of provider confidential master file.
Prepared various credentialing letters and other correspondence.
Verified provider documents by performing on-line queries from various resources, such as the National Practitioner Data Bank, American Medical Association, Drug Enforcement Administration, etc.
Ongoing acquisition of documentation required for credentialing of providers Monitored credentialing status to actively communicate progress reports to providers, medical staff administrators and/or healthcare coordinators.
Continuous oversight and training of staff on the utilization of technology that assists in credentialing process, e.g., PECOS, CAQH, databases.
Experience
5-7 Years
Level
Junior
Education
BS In Liberal Studies
Credentialing Supervisor Resume
Headline : An adaptable, motivated and personable Health Information Manager with an outstanding background in Health Organization and Communication. Having extensive experience and proven ability to deal within a hospital and corporate setting, meeting aggressive demands and delivering first class orders.
Skills : Registered Health Information Administrator, RHIA.
Description :
Oversaw day to day operations of a team consisting of all elements of the credentialing process.
Assisted in ensuring the coordination of initial and ongoing compliance with National Committee for Quality Assurance (NCQA) and Joint Commission (JC) accreditation standards.
Ensured that development and execution of Credentialing and other provider on-boarding functions are in accordance with applicable department policies and procedures.
Worked directly with client services, providers and external clients to ensure satisfaction and timeliness.
Generated performance measures.
Set goals and monitors performance against goals.
Performed in the implementation of several new software.
Experience
5-7 Years
Level
Executive
Education
GED
Credentialing Supervisor Resume
Objective : To acquire employment with a well-established company, that holds a proven track record of success. I desire to be part of a winning team and implement 12 years of Customer Service and Management related skills. My ideal company provides personal growth satisfaction, has a major focus towards customer satisfaction vendor relations as while ensuring above standard service level agreements are maintained.
Skills : Ms Access, Ms Excel, Vendor Relationships, LPS, As400, Adobe Suite, Recruiting, Client Services, Management Experience.
Description :
Oversaw day-to-day credentialing operations including but not limited to: ensuring credentialing files are processed timely and in compliance with regulations, timely license and DEA renewals, ongoing monitoring, and hospital privilege applications.
Developed, implemented, and improved departmental policies and procedures.
Handled all aspects of staff management for credentialing staff, including but not limited to: interviewing, hiring, evaluations, training and resolution of issues.
Oversaw audits related to Managed Care delegated credentialing and centralized verification office on an as needed basis.
Oversaw all delegation agreements and ensures compliance with requirements.
Oversaw all credentialing reports and ongoing monitoring Interacts with internal and external physicians, departments, health plans, hospitals and regulatory agencies to resolve credentialing issues.
Responsible for the accuracy and integrity of the credentialing database.
Experience
2-5 Years
Level
Executive
Education
GED
Credentialing Supervisor Resume
Objective : Credentialing Supervisor with 3 years of experience in Ensuring credentialing processes are completed accurately according to accreditations and regulations, Monitoring performance of employees through regular review of productivity reports and audits of work.
Skills : Monitoring Skills, Coaching Skills.
Description :
Supervised the credentialing process to assure timely and accurate processing of practitioner applications in compliance with regulatory, accrediting, contractual and corporate standards.
Modified the credentialing process to assure that production goals are met Liaison with practitioners, Network regulatory agencies and other departments within Independence Blue Cross to resolve practitioner-credentialing issues.
Interviewed prospective associates and recommended hiring decisions.
Supervised and developed full time and temporary employees.
Established and implemented performance improvement plans.
Experience
2-5 Years
Level
Executive
Education
MS
Credentialing Supervisor Resume
Summary : Credentialing Supervisor 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 : Programming Skills, Healthcare.
Description :
Received Commendable Accreditation from NCQA by maintaining compliance with all CIGNA HealthCare, Texas Department of Insurance and National Council for Quality Assurance guidelines.
Managed the credentialing and recredentialing process to ensure compliance with NCQA and state guidelines for the states of AK/AZ/CA/CO/GA/LA/OK/NV/TX/UT/WA, which included monitoring the credentialing database to ensure recredentialing timeliness.
Met with Medical Executives monthly in preparation for Credentialing Committee discussions, conducted monthly Credentialing Committee Meetings for the states of AK/CO/UT/WA, served as backup co-presenter for all other states aforementioned, managed the duties related to packet preparation and distribution to all committee panel members and updated credentialing database with committee decisions for distribution to impacted departments.
Managed Credentialing Assistants and Coordinators by auditing 10% of all individual files to ensure accuracy and appropriate documentation for committee review, monitored productivity to ensure monthly goals were met, implemented corrective action for low monthly quotas, served as primary contact for resolution to policy issues and met with staff monthly to ensure efficiencies in workflow and responsibilities.
Coordinated/initiated the termination process for inactive or non-responsive providers in accordance with contract provisions for all aforementioned states.
Coordinated with outside vendors to conduct monthly mailings to contracted providers due for recredentialing and managed the shipping/retrieval process between CIGNA HealthCare and the local file storage facility due to spacing limitations.
Maintained accreditation to NCQA for12 states, managed the operations for my hub location in TX, conducted and trained staff to conduct monthly credentials committee meetings for several states, file auditing, Skills Used Management, operations, file processing, file auditing.
Experience
7-10 Years
Level
Management
Education
Bachelors
Credentialing Supervisor Resume
Summary : Credentialing Supervisor professional with 16+ years of experience working in a private physician group and corporate environment. Familiar with all aspects of daily business operations including: Personnel, Human Resources, HIPAA, OSHA compliance, Payroll, Managerial Accounting and numerous administrative functions. Looking to contribute my skills and experience to a growing healthcare practice.
Skills : Detail-Oriented, Operating Skills.
Description :
Managed credentials meeting, maintained educational and occupational criteria.
Networked to increase reimbursement revenues.
Managed the implementation of proposed agreements.
Developed SOWs, conferred with management to ensure performance measurements.
Interpreted and disseminated guidelines set by state and federal licensing agencies/ managed care contracts.
Operated as the liaison between PPMW and third party administrators for the execution of monthly billing practices.
Responsible for tracking departmental metrics and identifying areas for improvement Oversees Credentialing Committees and approval of clean files between committee cycles.
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