credentialing coordinator resume example with 13+ years of experience

Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • Home: (555) 432-1000
  • Cell:
Professional Summary

Motivated Patient Account Representative offering 12+years of healthcare and customer service experience. Highly effective time management, conflict resolution and communication skills. Multitasking professional skilled in file efficiency and database integrity. A resourceful Credentialing Coordinator with a background in tracking the expiration of practitioner documents.

  • Microsoft Word
  • Data management
  • HIPPA Compliance
  • Financial Statements
  • Proficient in reading EOB's
  • Proficient in collections
  • Onboarding
  • CPT Coding
  • Medicare and Medicaid Billing
  • CMS-1500 billing forms
  • Managed Care
  • OSHA compliance
  • Power Point
  • Building Effective Relationships
  • Customer Billing
  • Interaction with Patients / Medical Personnel
  • Proficient in submitting appeals
  • Microsoft Excel
  • Team liaison
  • Insurance processing
  • Verbal / Oral Communication
  • Proficient in physician billing
  • Medical Billing
  • Claims appeals procedures
  • Business Communications
  • Medical Terminology
  • Outlook
  • Strong verbal communication
  • Medical Reimbursement and Billing
  • Financial Aid Counseling
  • Microsoft Office
  • Cash Deposits and Receipts
  • Work History
    Credentialing Coordinator, 02/2017 to Current
    Common SpiritSan Francisco, CA,
    • Communicate effectively with various parties each day using polished interpersonal and active listening skills
    • Worked closely with practitioners to help obtain privileges at their assigned healthcare facilities
    • Maintained accurate files, records and credentialing documents for over 60 providers
    • Track expiration dates on documents and communicate with appropriate staff to ensure that files are received
    • Assisted with managed care auditing processes and performed internal file audits
    • Conducted primary source verification's such as background checks and board certifications
    • Enrolled providers into DC,MD and VA Medicaid, Medicare and private insurance plans
    • Prepare records for site visits and file audits
    • Receive and evaluate applications to look for missing and inaccurate information
    • Obtain NPI numbers for providers and facilities and update existing profiles
    • Correspond with clients through email, telephone or postal mail
    • Developed excel spreadsheet to use office wide to track providers credentialing status
    • Maintain provider records to ensure re-credentialing is completed
    • Work with numerous insurance carriers to ensure processing of each providers application
    • Ensure effective communication with providers regarding credentialing status
    • Create, examine and monitor agreements between WWH and third party vendors
    Patient Health Billing Specialist, 06/2016 to 02/2017
    Whitman Walker HealthCity, STATE,
    • Performs tasks to support strong "front end" and "back end" billing and revenue cycle processes and EHR functionality
    • Verifies insurance coverage for over 30 walk-in patients and enters appropriate data accurately and promptly in database
    • Addresses billing inquiries promptly and accurately (including Telephone Encounters, e-mails, Action items, etc)
    • Provides support and notification to providers/clinicians when Prior-Authorization for services is required
    • Assists with submitting and obtaining Prior-Authorizations and notifies providers/staff when approved or denied
    • Assists with appealing denials
    • Staff billing phone line to address patient inquiries and staff inquiries for insurance verification, billing questions, questions about balances and insurance coverage
    • Service will be provided professionally, promptly, and accurately
    • Promptly checks voicemail and billing e-mail inbox and responds immediately but no within 24 hours or less
    • Established internal referral and pre-authorization process with appropriate staff
    • Verifies insurance benefits for incoming internal referrals, new patients, appointments
    • Processes patient payments via e Payment in database
    • Assists with billing claims, addressing denials, and re-submitting, as needed
    • Adheres to high ethical, professional, and confidentiality standards to protect patients' personal, financial, and health information DocuSign Compiles and maintains current and accurate data for all providers to include NPI registration/updates
    • Monitored multiple databases to keep track of all company inventory
    Insurance Follow-Up Specialist/ Patient Accounts Rep, 06/2007 to 06/2016
    Cardiovascular & Thoracic Surgery AssociatesCity, STATE,
    • Provide prompt and friendly service to all internal and external customers
    • Field patient and insurance calls regarding patient accounts receivable
    • Audit over 60 patient accounts for accuracy regarding charges, payments, demographics, insurance information and filing to ensure contractual agreements are being met
    • Request adjustments; write off, payment, transfers and refunds/recoups when appropriate
    • Work insurance aging reports, review claims status, patient eligibility, accuracy of account information and modify as needed
    • Submit patient claims, paper and electronic, after corrections have been made or when re-billing is needed
    • Review and reply to all insurance correspondence
    • Maintain current knowledge of insurance guidelines through newsletters and websites
    • Contact responsible party to resolve delinquent accounts; prepare payment plans and monitor adherence to plans by responsible party; direct accounts to outside collections agencies when necessary
    • May contact attorneys, employers, physicians, and others necessary to obtain information for resolution of credit and collection matters
    • Established report to identify and resolve accounts receivable and referral problems
    • Post data; verify and perform mathematical comp; maintains files
    • Compose and type routine correspondence, memos, letters, etc
    • Post payments daily using explanation of benefits
    Associate of Arts: Health Education, Expected in 2004 to Prince George's Community College - Upper Marlboro, MD

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    Resume Overview

    School Attended

    • Prince George's Community College

    Job Titles Held:

    • Credentialing Coordinator
    • Patient Health Billing Specialist
    • Insurance Follow-Up Specialist/ Patient Accounts Rep


    • Associate of Arts

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