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Credentialing Coordinator Resume Example

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Jessica Claire
Montgomery Street, San Francisco, CA 94105
Home: (555) 432-1000 - Cell: - resumesample@example.com - -
Career Overview
Driven and compassionate healthcare professional with extensive experience recruiting, developing and managing clinical staff. Accountable and responsible with a strong focus on patient wellness. Strong problem-solver with excellent time management skills.
Education and Training
Expected in 2014
Accounting: Accounting and Bookkeeping
Housatonic Community College - Bridgeport, CT
GPA:
Accounting and Bookkeeping
Expected in 2010
Bachelors of Science: Business Management
University of Bridgeport - ,
GPA:
Business Management
Expected in 2006
Associates of Science: Business Administration and Communications
Housatonic Community College - ,
GPA:
Business Administration and Communications
Skill Highlights
  • MS Word
  • ACCESS
  • PowerPoint
  • Excel
  • Windows
  • Lotus Notes and Outlook
  • Cactus and Medkinetics credentialing software

 

  • Good written communication
  • Proven patience and self-discipline
  • Conflict resolution
  • Relationship and team building
  • Staff training and development
  • Critical thinking proficiency
  • Strong work ethic
Professional Experience
02/2015 to Current
Credentialing Coordinator Phoenix Children's Hospital New York, NY,
  • Compiles and maintains current and accurate data for all providers.
  • Completes provider credentialing and recredentialing applications; monitors applications and follows-up as needed.
  • Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
  • Maintains corporate provider contract files.
  • Maintains knowledge of current health plan and agency requirements for credentialing providers.
  • Sets up and maintains provider information in online credentialing databases and system.
  • Tracks license and certification expirations for all providers to ensure timely renewals.
  • Ensures practice addresses are current with health plans, agencies and other entities.
  • Processes applications for appointment and reappointment of privileges Tracks license, DEA and professional liability expirations for appointed providers.
  • Maintain appointment files, and information in credentialing database.
  • Ensures compliance with the accrediting and regulatory agencies in regards to credentialing Developing and maintaining a working knowledge of the statutes and laws.
  • Responsible for the accuracy and integrity of the credentialing and clinical privileging database system and for ensuring the timeliness of credentialing/re-credentialing verification.
  • Duties include the gathering, verification and evaluation of confidential healthcare provider credentials as well as data entry of all credentialing information.
  • Adheres to the credentialing a priStrictly followed all federal and state guidelines for release of information. vileging process for assigned medical staff members, ensuring compliance with regulatory bodies like NCQA.
06/2014 to 03/2015
Credentialing Coordinator Phoenix Children's Hospital Mesa, AZ,
  • Responsible for coordinating, monitoring and maintaining the credentialing and re-credentialing process from foundation.
  • Facilitates all aspects of credentialing, including appointment, reappointment, monitoring and privileging for medical staff and health practitioners for over 700 multi-specialty physicians Ensures compliance with the accrediting and regulatory agencies in regards to credentialing Developing and maintaining a working knowledge of the statutes and laws.
  • Responsible for the accuracy and integrity of the credentialing and clinical privileging database system and for ensuring the timeliness of credentialing/re-credentialing verification.
  • Duties include the gathering, verification and evaluation of confidential healthcare provider credentials as well as data entry of all credentialing information.
  • Adheres to the credentialing a privileging process for assigned medical staff members, ensuring compliance with regulatory bodies like NCQA.
02/2014 to 05/2014
Administrative Assistant/Credentialing Specialist Hospital Sisters Health System - Corporate Decatur, IL,
  • Distributed incoming/outgoing mail.
  • Ordered office supplies; maintained supplies for patient rooms.
  • Maintained various company logs, schedules, phone and address directories.
  • Calculate time cards, overtime, salaries, wages, employee reimbursements, holiday pay and benefit time such as vacation, sick and personal days for employees.
  • Update all Bylaws and contracts with Vendors.
  • Gathering, verification and evaluation of confidential healthcare provider credentials as well as data entry of all credentialing information for the Guilford and Hamden locations.
  • Responsible for the accuracy and integrity of the credentialing and clinical privileging database system for the Guilford and Hamden locations.
  • Responsible for the accuracy and integrity of the endoscopy patient system.
10/2013 to 05/2014
Credentialing Specialist Jazz Pharmaceuticals Tampa, FL,
  • Ensures compliance with the accrediting and regulatory agencies in regards to credentialing Developing and maintaining a working knowledge of the statutes and laws.
  • Responsible for the accuracy and integrity of the credentialing and clinical privileging database system and for ensuring the timeliness of credentialing/re-credentialing verification.
  • Duties include the gathering, verification and evaluation of confidential healthcare provider credentials as well as data entry of all credentialing information.
  • Responsible for coordinating, monitoring and maintaining the credentialing and re-credentialing process.
  • Facilitates all aspects of credentialing, including appointment, reappointment, monitoring and privileging for medical staff and health practitioners.
01/2009 to 01/2013
Senior Case Management Specialist Metropolitan Life Insurance City, STATE,
  • Processed case load of 40 provider verification requests a day including verification of independent providers.
  • Played a key role in improving provider verification documentation.
  • Verified provider state licenses per state regulations.
  • Processed 10-30 Claim tasks and Power of attorneys.
  • Reviewed applications for any missing information.
  • Updated expiry dates in production system and minimize missing information tasks.
  • Returned calls within a timely manner and update database with new information.
  • Credentialing of providers and update clients plan of care for approved providers.
2007 to 2009
Case Management Specialist Metropolitan Life Insurance Company City, STATE,
  • Case Management Prioritized and reviewed new Long term applications cases.
  • Returned all voice mails, e-mails and portal messages within one business day.
  • New enrollment processing - liaison between licensing and underwriting.
  • Partnered closely with Underwriting and Vendor Relations daily to ensure properly handling of cases.
  • Strengthened relationships with agents and wholesalers by keeping them included in escalated issues and resolutions, and provided recommendations to agents whenever possible.
  • Adapted to changes within team, business or organization and be prepared to assist others as needed.
  • Utilized all available resources to ensure that cases are managed on time and with a high degree of quality.
01/2005 to 01/2007
Licensing and New Business Assistant Metropolitan Life Insurance Company City, STATE,
  • Entered and updated information in an Agent Maintenance tracker system.
  • Checked Brokers and agents confirmation and background check state files.
  • Assigned/Entered agents or brokers' information into a Data feed database and coding.
  • Investigated and resolved tasks in production database /archived appointment forms into proper agent files.
Skills and Qualifications
Healthcare, Case Management, contracts, clients, Customer Service, data entry, databases,documentation, Staff Training, forms, Team building, Leadership, Lotus Notes, ACCESS, Excel, Microsoft Office, Outlook, PowerPoint, Windows, MS Word, monitors, Policies, Processes, Coding, Project Leadership, Quality, phone, plan of care, Underwriting, Vendor Relations, great organizational skills

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Resume Strength

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  • Length
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Resume Overview

School Attended
  • Housatonic Community College
  • University of Bridgeport
  • Housatonic Community College
Job Titles Held:
  • Credentialing Coordinator
  • Credentialing Coordinator
  • Administrative Assistant/Credentialing Specialist
  • Credentialing Specialist
  • Senior Case Management Specialist
  • Case Management Specialist
  • Licensing and New Business Assistant
Degrees
  • Accounting
  • Bachelors of Science
  • Associates of Science

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