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credentialing coordinator resume example with 12+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
  • :
Professional Summary

I am looking for a place where I can contribute my skills and drive. Perhaps your firm could benefit from my diverse background in credentialing, insurance verification and authorization, billing, collections, accounts payable and receivable and overall managing the office. Ability to multi-task and detail-oriented: When you hire me, you get someone who can work with various individuals and groups to get a job done, which is exactly what I needed to handle a job set for me and act as a liaison between the patients, doctors, insurance companies and attorneys. This position appeals to me because of my interests and extensive experience in Credentialing and Medical staff operations, administrative assistant, billing, collections and accounting. Articulate Credentialing Coordinator with exemplary critical thinking and decision making talents. An energetic professional with more than 7 years' requesting credentialing documents from providers. Ready to apply talents in credentialing and document work flows with a new organization.

Skills

Increased office organization by developing more efficient filing system and customer database protocols.
Received merit raise for strong attention to detail, exemplary customer service and team-player attitude.
Research Investigated any necessary information for proper billing for insurance companies, patients and DMEs such as proper billing codes.
Research Investigated and analyzed client complaints to identify and resolve issues.
Customer Service Handled customers effectively by identifying needs, quickly gaining trust, approaching complex situations and resolving problems to maximize efficiency.
Medical Records Reviewed medical records for completeness, assembled records into standard order and filed records in designated areas according to alphabetic and numeric filing system

Re-credentialing processes

Records and file management

Documentation work flows

Practitioner application monitoring

Effective written and verbal communication

Credentialing audits

Work History
Credentialing Coordinator, 11/2013 - Current
Ahmc Healthcare Inc. Monterey Park, CA,
  • Audit, data entered, and performed primary source verifications in accordance with various regulatory agencies for credentialing, re-credentialing, and delegated accounts
  • Audit, data entered, and performed primary source verifications in accordance with various regulatory agencies for credentialing, re-credentialing, and delegated accounts
  • Maintain credentialing database while tracking all direct provider contract data
  • Handle on-boarding and credentialing of over 300 ED providers, 80 Dental providers and 80 Behavioral Health providers for Family Health Center at NYU
  • Perform primary and secondary source verifications of credentials according to departmental policy
  • Maintain all medical license, Drug Administration and malpractice insurance for physicians and mid-level providers
  • Ensure compliance with national standards of quality organizations
  • Audit, data entered, and performed primary source verifications in accordance with various regulatory agencies for credentialing, re-credentialing, and delegated accounts
  • Resolve practitioner concerns in timely manner
  • Analyze reports to ensure processing compliance
  • Produce canned reports and maintained Visual Cactus Database
  • Assist in interpretation and enforcement of Medical Staff Bylaws and Joint Commission standards and provide guidance to Medical and Dental Staff when necessary
  • Maintain and updated all practitioner databases
  • Review credentials files and ran reports for potential red flags
  • Assist in areas of budgeting, performance improvement, and compliance as needed
  • Attend monthly Medical Executive Committee, Credentials Committee, and Quarterly Medical Staff Meetings with hospital administrators as required
  • Knowledge and effectiveness in insurance portals including CAQH
  • Liaised between employees and senior leadership to address inquiries, complete contract processing and foster problem resolution
  • Tracked expiration dates on documents and communicated with appropriate staff to avoid late filing
  • Communicated effectively with various parties each day using polished interpersonal and active listening skills
Collection and Credentialing Consultant , 11/2012 - 11/2013
Baylor Scott & White Health Royse City, TX,
  • Ensure proper Collections for 7 providers and Manage all aspects of Credentialing for 5 providers
  • Create and maintain spreadsheets using advanced Excel functions and calculations to develop reports and lists
  • Receive and distributed faxes and mail in a timely manner and Organize files, developed spreadsheets, faxed reports and scanned documents
  • Properly routed agreements, contracts and invoices through the signature process
  • Thoroughly investigated past due invoices and minimized number of unpaid accounts
  • Research and resolved collections and billing disputes with tact and efficiency
  • Carefully reviewed medical records for accuracy and completion as required by insurance companies and Cooperate with Medicare, Medicaid and private insurance providers to resolve billing issues
  • Design electronic file systems and maintained electronic and paper files
  • Contact insurance providers to verify correct insurance information and get authorization for proper billing codes and contacted providers to discuss status of re-billing and reimbursement process to ensure account resolution
  • Handle and processed confidential patient information in accordance to HIPAA compliance standards and Coordinate admission processes and prepared medical records and agreement packets
  • Successfully led key projects which resulted in increased revenue
Collections and Billing Specialist/Credentialing, 01/2012 - 10/2012
XXI CENTURY RADIOLOGY AND IMAGING, P. C City, STATE,
  • Billing and Collection for Medicaid, Medicare, private insurance plans, No-Fault, Workers Compensation and third-party insurances
  • Managed insurance verification, advising staff of patient's plan specific instructions
  • Oversee all aspects of credentialing and advising doctors of all required documents
  • Handled insurances billing, collection, accounts payable and receivable
  • Assisted manager with running of the office including payroll, cash, questions and updates
  • Assisted staff with all questions regarding financial fees and responsibilities to patients
  • Managed the receptionist area, including greeting visitors and responding to telephone and in-person requests for information
  • Maintained detailed administrative and procedural processes to improve accuracy and efficiency and managed medical supply inventory, insurance records, patient charts and company files using online tracking system
  • Resolved conflicts and negotiated mutually beneficial agreements between parties
Insurance Verification Specialist, 11/2009 - 02/2011
ART BILLING AND COLLECTION, INC City, STATE,
  • Handled insurance verification and authorizations for 15 doctors for a free-standing surgical facility
  • Worked with insurance companies and patients/clients to resolve issues and answer inquiries and handled inquiries regarding payment of invoice
  • Data entry and correspondence follow up, filing, copying, typing, scanning and as needed
  • Managed daily office operations and maintenance of equipment
  • Created and maintained spreadsheets using advanced Excel functions and calculations to develop reports and lists
  • Contacted insurance providers to verify correct insurance information and get authorization for proper billing codes
  • Observed strict procedures to protect sensitive patient information, including medical records and payment data
Education
Bachelor of Science: Liberal Arts, Expected in 2010
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Touro College, New York School of Career and Applied Studies - Brooklyn, NY,
GPA:
Status -

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Resume Overview

School Attended

  • Touro College, New York School of Career and Applied Studies

Job Titles Held:

  • Credentialing Coordinator
  • Collection and Credentialing Consultant
  • Collections and Billing Specialist/Credentialing
  • Insurance Verification Specialist

Degrees

  • Bachelor of Science

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