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credentialing coordinator resume example with 6+ 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. Been in Healthcare for the past 8 years with expertise in Provider Operations, Patient Assistance and Leadership assistance.

Skills
  • Networking and Partnership Development
  • Credentialing Requirements
  • Problem Resolution
  • Credentialing Audits
  • Active Listening
  • Personnel Management
  • Special Projects
  • Credential Verification
  • Credentialing Data Coordination
  • Training Strategies
  • Complex Problem-Solving
  • Time Management
Work History
Credentialing Coordinator, 07/2021 to Current
Acadia HealthcareNew Baltimore, MI,
  • Communicate effectively with various parties each day using polished interpersonal and active listening skills.
  • Maintain accurate files, records and credentialing documents in well-maintained databases.
  • Work multiple delegated projects, practitioner adds, Location adds and Practitioner changes for team.
  • Establish 98% Quality Audit and Production goals monthly
  • Implement new efficient ideas for the team that will effectively, increase productivity and Quality work.
  • Assist on additional projects given my leadership
  • Train and Shadow new employees or individuals assisting with work load.
Intake Representative/Scheduler, 11/2020 to 07/2021
University Of Minnesota Physicians- M HealthCity, STATE,
  • Supported Call Center with high call volumes, scheduling appointments, and performing verifications according to provider rules, and guidelines plus, documenting service requests.
  • Obtained and confirm permanent billing and demographic information, and accurately enter patient insurance information into the system, and complete the patient registration process in an accurate manner.
  • Scheduled for six different Urology Clinics in the Fairview System and One Women's Health Clinic.
  • Performed Administrative tasks as needed
  • Provided Service Support to Patients who request our care and from Physicians Referrals.
  • Navigated through dedicated software's such as: EPIC, Microsoft Edge, Excel, Revoation, Sype, Microsoft Teams, OneNote, Outlook, Citrix, Gateway and Workday.
Behavioral Health Credentialing Specialist, 09/2019 to 11/2020
Optum, UnitedHealth GroupCity, STATE,
  • SME (Subject Matter Expert) for the credentialing department.
  • Trainer for the credentialing department for East Cost and Southern Region States.
  • Complied and Maintained current and accurate data for all providers
  • Monitored recredentialing applications and follow-up with providers and network managers as needed
  • Maintained Copies of Current State Licenses, DEA Certifications, Malpractice coverage, CDS and any other required credentialing documentation for all providers
  • Maintained knowledge of current plan and agency requirements for credentialing providers
  • Ensured provider demographic information is accurate in our system
  • Navigated and had knowledge of multiple systems such as: Salesforce, OHBS facets, Microsoft 360, Outlook, Xcel, Word and Epuf
  • Participated in individual or group projects as directed by leadership
Business Segment Liaison Administrator, 12/2015 to 09/2019
Optum/UnitedHealth GroupCity, STATE,
  • SME (Subject Matter Expert) and BSL (Business Segment Liaison) trainer for the Business segment
  • Managed specific processes for the Provider Data Management department.
  • Onboarded Contractors and Full time Employees for the business segment, including their access requests
  • Handled travel expenses and expense reports for Directors, Managers & Supervisors in our designated system.
  • Handled administrative paperwork including: faxing, printing, system handling and software knowledge, such as: OHBS Facets, salesforce, Cosmos, NMDB, BATT utility, NDB, ORBIT Tableau, BSL Site, Teach software apps, proficiency in SharePoint. Microsoft 360, Microsoft outlook, Word ,Excel, VISO, Access, Accent, CITRIX, UBH Linx, Ect
  • Managed Approval of systems for the department in OHBS Facets, EPUF and Orbit Tableau.
  • Managed Behavioral Health incoming and Return Mail- Researched and Investigated return mail
  • Managed Business Segment Supply Requests and ordered through our designated vendors
  • Facilitated meetings and scheduled meetings for Directors, Managers and Supervisors.
  • Managed different Reportings such as; ERA Reportings, NDB Reports, ect
  • Managed different Optum File Team Email Boxes For the Operations Support Service Team
  • Managed Physical Health SharePoint Site
  • Head Event Coordinator, Planned and organized events for the department
  • Emergency Response Team Lead and Building Head Response Lead
Education
Bachelor of Science: Business Management, Expected in 11/2016 to Rasmussen College - Eagan, MN,
GPA:
Associate of Applied Science: Business Administration, Expected in 12/2012 to Minnesota School of Business - Shakopee,
GPA:

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Resume Overview

School Attended

  • Rasmussen College
  • Minnesota School of Business

Job Titles Held:

  • Credentialing Coordinator
  • Intake Representative/Scheduler
  • Behavioral Health Credentialing Specialist
  • Business Segment Liaison Administrator

Degrees

  • Bachelor of Science
  • Associate of Applied Science

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