Credentialing Coordinator Resume Example NEW YORK UNIVERSITY Faculty Group Practice

CREDENTIALING COORDINATOR

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 CoordinatorNEW YORK UNIVERSITY Faculty Group Practice - New York, NY11/2013 - Current

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 SOFTPRO MEDICAL SOLUTIONS, INC - Brooklyn, NY11/2012 - 11/2013

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/CredentialingXXI CENTURY RADIOLOGY AND IMAGING, P. C - Brooklyn, NY01/2012 - 10/2012

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 SpecialistART BILLING AND COLLECTION, INC - Brooklyn, NY11/2009 - 02/2011

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 ArtsTouro College, New York School of Career and Applied Studies - Brooklyn, NY2010

Resume Overview

Companies Worked For:

NEW YORK UNIVERSITY Faculty Group Practice
SOFTPRO MEDICAL SOLUTIONS, INC
XXI CENTURY RADIOLOGY AND IMAGING, P. C
ART BILLING AND COLLECTION, INC

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 : Liberal Arts

Credentialing Coordinator Resume Example

Resume Score: 80%

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