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Credentialing Quality Assurance Specialist resume example with 16+ years of experience

Jessica
Claire
resumesample@example.com
(555) 432-1000,
, , 100 Montgomery St. 10th Floor
:
Summary

Dedicated Administrative professional with a solid background of 14 years in high-volume office environments, focused on delivering exceptional clerical and operational support for Healthcare, Insurance and Oil & Gas professionals. Personable and communicative with friendly demeanor and sound judgment to handle diverse daily tasks with minimal oversight. Well-versed in managing daily operations and project needs. Highly resourceful with proven history of tackling complex projects with superior results.

Skills
  • PC proficient
  • Advanced MS Office Suite knowledge
  • Human resources best practices
  • Data entry documentation
  • Data entry and evaluation
  • Confidential document control
  • Expense reporting
  • Time management
  • Event coordination
  • Detail-oriented
  • Multi-line phone systems
  • Database entry
  • Problem resolution
  • Scheduling and calendar management
Education and Training
LoneStar College Conroe, TX, Expected in : Business - GPA :
Everest Institute Houston, TX, Expected in 01/2009 Current Certification: Dental Hygiene : - GPA :
Parkview Baptist Houston, TX, Expected in 09/2007 High School Diploma : - GPA :
Certifications

Texas Notary Public Commission Expires 2/21/2021

Experience
Ibi Group - Licensing Credentialing Specialist
Columbus, OH, 01/2022 - Current

• Completes provider credentialing and re-credentialing licensing applications within State guidelines.
• Monitor provider license application statuses; conduct follow-up and problem resolution as needed.
• Coordinate with practice leadership, hospitals, and providers to complete licensing process, including any additional documentation, information, or applications.
• Track license and certification expirations for all providers to ensure timely renewals.
• Maintain accuracy of provider data in credentialing databases systems.
• Ensure strict confidentiality of credentialing licensing files and databases.
• Keep management informed of progress and escalate issues as needed related to license/DEA & CDS status.
• Uphold all credentialing specific policies and procedures.
• Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
• Completes renewal process for (DEA/CDS) controlled substance registrations and state licenses.
• Requests FSMB, FCVS, and AMA profiles when applicable.
• Coordinate completion of all requirement documents and forms for state licensure.
• Complete and review all license applications to ensure accuracy prior to submission.
• Sets up and maintains provider information in online credentialing databases and systems.
• Assists Radiologists through the licensing process.
• Supports with special projects. Preforms miscellaneous job-related duties as assigned.

Crst International - Credentialing Quality Assurance Specialist
Bloomville, OH, 02/2020 - 01/2022
  • Responsible for maintaining active status for all providers by successfully completing license renewals.
  • Apply for and renew annually all provider licenses; Professional, DEA, Controlled Substance.
  • Maintain informational resources, tracking and documenting requests for updates, certification and credentialing.
  • Pre complete applications and organized all paperwork.
  • Work closely with leadership, vendors, and providers to ensure licensing process runs smoothly.
  • Maintain accurate provider profiles in Oneapp with current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
  • Maintain internal provider grid to ensure all information is accurate and logins are available.
  • Advise Providers on renewal procedures.
  • Release information to State Medical Boards as required by law.

National Beverage - Compliance Coordinator
Warren, MI, 01/2017 - 09/2019
  • Add NCM to Nursys e-notify.
  • Create Welcome to axiom email.
  • Assign Licensure.
  • Make licensure packets.
  • Request prepayments and checks from accounting for licensure fees.
  • Itemize online fees for Applications, Fingerprints, and License Verifications.
  • Mail applications, fingerprint cards, and any other documents associated with Licensure.
  • Request transcripts and license verifications.
  • Register fingerprint cards.
  • Schedule fingerprint appointments.
  • Search for Criminal History Record Checks and Disciplinary action against license.
  • Log any correspondence with board received via telephone, mail, or email.
  • Email delinquent notices.
  • Assist w/ expense reports.
  • Review and Pre- Approve Expense Reports.
  • Send email for license expiration reminder.
  • Keep track of receipts for licensure expenses.
  • Keep licensure files up to date with board changes.
  • Maintain licensure checklist.
  • Notarize documents.
  • Review case load report for licensure needs.
  • Update Dispatch spreadsheet for CS.
  • Update licensing spreadsheets- licensing recognition, team sheet, and status log.
  • Prepare and email reviews & focused audit reports.
Professional Medical Insurance Services - Executive Administrative Assistant
City, STATE, 05/2007 - 12/2016
  • Planned and coordinated logistics and materials for board meetings, committee meetings and staff events.
  • Created detailed expense reports and requests for capital expenditures.
  • Transacted and generate invoices with premiums, taxes, and fees.
  • Process Finance Agreements.
  • Processed client rebate reconciliation, reporting and check requests.
  • Update and review marketing status.
  • Ordered and distributed office supplies while adhering to a fixed office budget.
  • Helped distribute employee notices and mail around the office.
  • Answers abundant phone calls for a multi-line phone, direct calls, and take messages.
  • Compiled company information and related material and distributed it to candidates.
  • Issued Certificates of Insurance.
  • Provided Credentialing Letters and Loss Runs for Physicians, Hospitals, and Processing Centers.
  • Apply and Renew Company and Employee Licenses.
  • Maintain Files and Records/ Duties include heavy filing, fax, and copy.
  • Coordinated board and committee meetings, including schedules and information preparation and distribution.
  • Served as corporate liaison between the finance, IT and marketing departments.
  • Processed client rebate reconciliation, reporting and check requests.
  • Planned and coordinated logistics and materials for board meetings, committee meetings and staff events.
ExxonMobil Production Corporation - Administrative Assistant
City, STATE, 05/2005 - 05/2007
  • Collect, sort, distribute and prepare mail.
  • File and maintain records.
  • Transmit information or documents using computer, mail, or facsimile machine.
  • Receive payment and record receipts for services.
  • Type, format, proofread and edit documents using computers.
  • Compile, copy, sort and file records of office activities business transactions.
  • Inventory order materials, supplies and services.
  • Answered and managed incoming and outgoing calls while recording accurate messages.
  • Greeted numerous visitors, including VIPs, vendors and interview candidates.
  • Maintained a clean reception area, including lounge and associated areas.
  • Organized all new hire, security and temporary paperwork.
  • Assisted senior recruiting staff with career fairs and recruiting events.

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Resume Overview

School Attended

  • LoneStar College
  • Everest Institute
  • Parkview Baptist

Job Titles Held:

  • Licensing Credentialing Specialist
  • Credentialing Quality Assurance Specialist
  • Compliance Coordinator
  • Executive Administrative Assistant
  • Administrative Assistant

Degrees

  • Some College (No Degree)
  • Current Certification: Dental Hygiene
  • High School Diploma

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