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credentialing analyst resume example with 20 years of experience

Jessica Claire
, , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
Home: (555) 432-1000 - Cell: - resumesample@example.com - -
Professional Summary

Experienced Credentialing Specialist adept at conducting application reviews and primary source verifications. Excellent relationship-building, problem-solving and communication skills. Achievements include completing more than 2000 healthcare provider applications each month with no critical errors. Highly organized and detail-oriented with in-depth knowledge of insurance regulations. Experienced administrative professional with 10+ years in provider credentialing services. Works productively with facilities, provider groups and individual professionals. Knowledgeable about application requirements for government and private insurance plans. Goal-oriented and welcoming with proven history of modernizing traditional offices to maximize patient satisfaction. Dedicated to organization and collaboration with over 10 years in Administration industry. Highly organized Credentialing Analyst knowledgeable about healthcare processes and administrative requirements. Qualified to deal with insurance documentation, update charts and manage business correspondence. Versatile Administrative professional well-versed in healthcare practices, compliance standards and operations. Excellent problem-solver and clear communicator with positive and upbeat personality. Meticulous Analyst with 10 years of experience in the Medical Dental industry. Fantastic attention to detail, collaboration skills and typing ability. Committed to streamlining organizational procedures to optimize office settings. Enthusiastic eager to contribute to team success through hard work, attention to detail and excellent organizational skills. Clear understanding all Medical Credentialing and standards

Skills
  • Insurance credentialing processes
  • Facility support
  • Accreditation information management
  • Application coordination
  • Excell and Access expertise
  • Group assistance
  • Provider enrollment
  • Provider Relations
  • Good listening skills
  • Teamwork
  • Responsible
  • Data management
  • Excellent work ethic
  • Microsoft Office
  • Leadership
  • Conflict resolution
  • Planning and Coordination
  • Critical thinking
  • Interpersonal Communication
Work History
12/2012 to Current
Credentialing Analyst Relx Group Louisville, KY,
  • Received and evaluated applications to look for missing and inaccurate information.
  • Conducted primary source verifications such as background checks and board certifications.
  • Obtained NPI numbers for providers and facilities and updated existing profiles.
  • Prepared records for site visits and file audits.
  • Managed financial documentations such as expense reports and invoices.
  • Received, recorded and addressed incoming and outgoing communication via telephone and email.
  • Completed skilled administrative work to support all office staff and operational requirements.
02/2012 to 12/2012
Credentialing Coordinator Phoenix Children's Hospital Bloomington, MN,
  • Communicated effectively with various parties each day using polished interpersonal and active listening skills.
  • Tracked expiration dates on documents and communicated with appropriate staff to avoid late filing.
  • Received and evaluated applications to look for missing and inaccurate information.
  • Conducted primary source verifications such as background checks and board certifications.
  • Worked closely with practitioners to help each obtain privileges at assigned healthcare facilities
  • Assisted with managed care auditing processes and performed internal file audits.
  • Maintained accurate files, records and credentialing documents in well-maintained databases using Excell and Access
  • Prepared records for site visits and file audits.
  • Obtained NPI numbers for providers and facilities and updated existing profiles.
  • Improved office efficiency by effectively managing internal communications and correspondence.
  • Improved organizational filing systems for confidential employee records, resulting in improved accessibility and efficiency.
  • Collected and analyzed information to monitor compliance outcomes and identify and address trends of non-compliant behavior.
  • Administered benefits programs, analyzed compensation and other competitive data and prepared budgets.
01/2000 to 10/2010
Credentialing Specialist Gw Medical Faculty Associates Alexandria, VA,
  • Received and evaluated applications to look for missing and inaccurate information.
  • Conducted primary source verifications such as background checks and board certifications.
  • Obtained NPI numbers for providers and facilities and updated existing profiles.
  • Prepared records for site visits and file audits.
  • Collected and analyzed information to monitor compliance outcomes and identify and address trends of non-compliant behavior.
Education
Expected in
No Degree: Trade School in To The Hygiene Program
Cypress College - Cypress, CA
GPA:
Expected in 06/1997
High School Diploma:
El Toro High School - Lake Forest, CA
GPA:
Additional Information

Work and knowledgeable in all boards DEA Medical and Medical all credentialing standers URAC,NCQA,Joint Commissions. Understand and knowledgeable with NPDB and boards.

Languages
Spanish:
Full Professional
Negotiated:

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Resume Overview

School Attended

  • Cypress College
  • El Toro High School

Job Titles Held:

  • Credentialing Analyst
  • Credentialing Coordinator
  • Credentialing Specialist

Degrees

  • No Degree
  • High School Diploma

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