Credentialing Quality Specialist Resume Example
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CREDENTIALING QUALITY SPECIALIST
Professional Summary
Progressive experience in healthcare regulation and compliance and service coordination. Highly organized and efficient in a fast-paced environment, communicating effectively at all organizational levels, with clients and stakeholders. Demonstrated ability to build trusting relationships. Ability to think critically, solve problems, plan and organize activities and deliver excellent client relationships.
Skills
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Work History
Home Health AideBickford Senior Living
- Delivered assistance to elderly client in daily activities including bathing, dressing, physical transfers and care for incontinence.
- Offered support for client mental and emotional needs to enhance physical outcomes and overall happiness.
- Developed rapport to create safe and trusting environment for care.
- Promoted development of healthy lifestyle to meet health and wellness objectives.
- Coordinated daily medicine schedules and administration to help client address symptoms and enhance quality of life.
- Increased medication knowledge and medical terminology prowess through consistent research and continuing education.
- Maintained clean, safe and well-organized patient environment.
- Maintained records of patient care, condition, progress or problems to report, and discussed observations with physicians.
- Worked to improve and enhance patient life through effective and compassionate care.
Pharmacy TechnicianBerkshire Healthcare
Credentialing Quality SpecialistJun 2019 - Current
IntellicentricsSaginaw , STATE
IntellicentricsSaginaw , STATE
- Eliminated operational process gaps by implementing new methods of standardized training.
- Increased credentialing quality rate by 30% by establishing goals, overseeing performance and implementing a continuous training plan.
- Provide regular updates to team leadership on quality metrics, communicating consistency problems or process deficiencies with Operations leadership.
- Collect and analyze information to monitor compliance outcomes and identify and address trends of credentialing critical errors.
- Maximize team knowledge and productivity by providing effective training, monitoring and directing employees in application of best practices and NCQA regulatory standards.
- Perform continuous evaluations of process content and training procedures in order to enhance delivery and improve effectiveness.
- Mentor new hires, resulting in stronger staff development and increased productivity.
- Effectively train new employees on credentialing processes and company procedures.
- Continuously apply strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
- Execute regular process updates to reduce discrepancies and enhance credentialing performance rates.
- Maximize performance by monitoring daily activities and mentoring team of 30.
- Deliver feedback to decision-makers regarding employee performance and training needs.
- Set, enforce and optimize internal policies to maintain efficiency and responsiveness to client expectations.
Independent Life And Health Insurance Agent Jun 2018 - Feb 2019
WalmartWilliamstown , STATE
WalmartWilliamstown , STATE
- Cultivated new business by offering presentations on Medicare to individuals and groups on the subject of Medicare.
- Built relationships with clients through active listening and empathy to provide excellent service.
- Maintained high standards of customer service by building relationships with clients.
- Scheduled fact-finding appointments and consultations to determine client needs and overall financial situations resulting in 80% closing ratio.
Lead QIDP Jan 2018 - Jun 2018
AmeriLife Of TexasCity , STATE
AmeriLife Of TexasCity , STATE
- Designed individualized service plans that took into account the clients' goals and preferences.
- Maintained accurate records and full compliance with Federal and State government regulations and agency guidelines.
- Served as the central point of contact for clinical and administrative professionals.
- Improved delivery of patient care through reviewing and implementing improvements to clinical and programmantic approaches.
- Interviewed clients, families or groups to assess situations, limitations and issues and implement services to address needs.
- Assessed clients for abuse and neglect to compile documentation for court reports.
- Formulated treatment plan strategies with multidisciplinary teams to provide comprehensive and continuous care plan.
- Helped clients develop new coping mechanisms and techniques to drive behavior modification.
- Recommended long-term residential treatment, short-term residential treatment and individualized and group home living settings.
QIDP EducatorAug 2008 - May 2017
Texas Department Of Health And Human ServicesCity , STATE
Texas Department Of Health And Human ServicesCity , STATE
- Routinely collaborated with department managers to correct problems and improve services.
- Maintained excellent communication between department heads, medical staff and governing boards by attending board meetings and synchronizing interdepartmental functions.
- Served on executive administrative team and collaborated on strategic planning, decision making, goal setting, and operational changes.
- Educated staff on state and federal statutes, rules and regulations governing home care services.
- Led clinical team in delivering care services that promoted optimal resident health.
- Interpreted and communicated new or revised policies to staff.
- Skillfully developed departmental goals, objectives, standards of performance, policies and procedures.
- Demonstrated ability to lead and motivate outstanding integrated healthcare teams.
- Investigated, provided and submitted information to Quality Assurance Department about special incidents, events and complaints.
- As member of facility administrative team, collaborated on strategic planning and ensuring that practice operations aligned with organizational mission, vision, and goals.
- Achieved high staff morale and retention through effective communication, prompt problem resolution, proactive supervisory practices and facilitating a proactive work environment.
- Consistently complied with applicable laws and regulations and ensured facility adhered to Medicare and Medicaid regulations.
- Initiated audit process to evaluate thoroughness of documentation and maintenance of facility standards.
- Eliminated process gaps by implementing new methods of standardized training.
- Performed continuous evaluations of content and plans in order to enhance delivery and improve effectiveness.
- Acted as training subject matter expert and provided extensive technical support to different departments.
- Educated employees on specific QA standards and confirmed all standards were being maintained.
Education
Master Of Business Administration2014
University Of PhoenixCity, State
University Of PhoenixCity, State
Bachelor Of Science In Business: Information Systems2011
University Of PhoenixCity, State
University Of PhoenixCity, State
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Resume Overview
School Attended
- University Of Phoenix
Job Titles Held:
- Home Health Aide
- Pharmacy Technician
- Credentialing Quality Specialist
- Independent Life And Health Insurance Agent
- Lead QIDP
- QIDP Educator
Degrees
- Master Of Business Administration 2014
Bachelor Of Science In Business : Information Systems 2011
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