Credentialing Quality Assurance Specialist resume example with 16+ years of experience
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.
- 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
Texas Notary Public Commission Expires 2/21/2021
Columbus, OH, 01/2022 - Current
ā¢ Completes provider credentialing and re-credentialing licensing applications within State guidelines.
ā¢ Monitor provider license application statuses; conduct follow-up and problem resolution as needed.
ā¢ Coordinate with practice leadership, hospitals, and providers to complete licensing process, including any additional documentation, information, or applications.
ā¢ Track license and certification expirations for all providers to ensure timely renewals.
ā¢ Maintain accuracy of provider data in credentialing databases systems.
ā¢ Ensure strict confidentiality of credentialing licensing files and databases.
ā¢ Keep management informed of progress and escalate issues as needed related to license/DEA & CDS status.
ā¢ Uphold all credentialing specific policies and procedures.
ā¢ Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
ā¢ Completes renewal process for (DEA/CDS) controlled substance registrations and state licenses.
ā¢ Requests FSMB, FCVS, and AMA profiles when applicable.
ā¢ Coordinate completion of all requirement documents and forms for state licensure.
ā¢ Complete and review all license applications to ensure accuracy prior to submission.
ā¢ Sets up and maintains provider information in online credentialing databases and systems.
ā¢ Assists Radiologists through the licensing process.
ā¢ Supports with special projects. Preforms miscellaneous job-related duties as assigned.
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.
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.
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.
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
By clicking Customize This Resume, you agree to ourĀ Terms of UseĀ andĀ Privacy Policy
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