Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000,

Detail-oriented employee with expertise in tracking practitioner documentation and exemplary communication skills. An enthusiastic Credentialing Coordinator highly talented in maintaining files, reviewing certifications and following up with the application process. Highley organized, proactive and punctual with team-oriented mentality.

  • Computer skills
  • Organizational skills
  • Insurance procedures
  • Application management
  • License verifications
  • Community health center credentialing
  • Facility credentialing
  • Regulatory requirements
  • Records maintenance
11/2019 to Current Credentialing Specialist Change Healthcare Inc. | Bronx, NY,
  • Complete provider credentialing and recredentialing applications; monitor applications and follow up as needed.
  • Maintain copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all employed providers.
  • Maintain knowledge of current health plan and agency requirements for credentialing providers.
  • Enroll and Maintain Provider profiles in CAQH.
  • Ensure practice addresses are current with health plans, agencies and other entities.
  • Maintain informational resources, tracking and documenting requests for updates, certification and credentialing.
  • Perform primary source verifications such as criminal histories, licenses and board certifications.
  • Check applications for missing information and organize all paperwork.
  • Address credentialing requests, oversee compliance with governmental and organizational guidelines regarding tiered data access.
  • Confirm facility and user credentials to initiate and maintain registration and enrollment processes.
  • Complete enrollments into Medicaid, Medicare and private insurance plans.
  • Process documents and status-change requests, conduct followup assessment regarding enrollment inquiries.
  • Set up NPI numbers for providers and facilities and update current profile information.
  • Perform database queries, compiling information according to requests and logging logistics changes.
  • Follow up on claim rejections related to credentialing
  • Helped enroll clinics as Rural Health Clinics
03/2019 to Current Medical Staff Coordinator Providence Health & Services | Issaquah, WA,
  • Coordinate the process of credentialing and privileging of the Medical Staff, advance practice providers and other allied health professionals under the auspices of the Medical Staff Organization. This includes the compilation of needed information, tracking the status, and communicating with the provider for outstanding items.
  • Review all applications and other documents for completeness and initiate verification of all information contained in them.
  • Process requests for addition/deletion of privileges and change of staff status through the appropriate services and committees.
  • Keeps abreast of Joint Commission on Accreditation of Healthcare Organization standards as they relate to the credentialing and medical staff organization.
  • Assure that documentation is in the credentials file for staff members required to maintain ACLS, ATLS, NRP, and PALS certification.
  • Maintain up-to-date credential files on all Credentialed Staff members, including all documentation required by the Credentialed Staff Bylaws.
  • Advise committee chairman when a meeting of their committee is due and follows through to see that such meeting is scheduled and communicated to the membership.
  • Prepare agenda, assemble minutes, reports, correspondence and other data, as required, for meetings of all Medical Staff Committees and the full Medical Staff. Attend the meetings, obtain signatures from CEO, Chief of Staff, and Department Chairs as needed. Notifies those necessary for MEC recommendations.
  • Assist in managing medical staff organization including, but not limited to: reminder calls to Committee members, data entry of monthly statistics, assisting with any correspondence, transcription, etc.; tracking medical staff elections and committee appointments; and maintaining Credentialed Staff Bylaws, The Credentialing Manual, and Rules & Regulations.
  • Publish the on-call emergency schedule for all medical specialties based upon the information and individuals provided by the individual medical specialties
  • Assist in revisions to The Credentialing Manual and the Rules & Regulations by monitoring policy changes made by the Medical Executive Committee. Active Staff reviews revision and MEC ratifies action at their next meeting. Copies of revision mailed to Credentialed Staff.
07/2012 to 03/2019 Patient Financial Representative Houston Behavioral Healthcare Hospital | Houston, TX,
  • Put together settlement options and development payment plans.
  • Worked with insurance companies and patients to determine best courses of action.
  • Added current information to system accounts, including demographic information and payment methods.
  • Evaluated patients for unique needs and assistance options.
  • Used sliding payment scale to assess fair charges for patient healthcare.
  • Collaborated with all relevant parties to resolve billing issues, insurance claims and patient payments.
  • Resolved inquiries from patients, families and external payers.
  • Reached out to patients once insurance was billed in order to obtain payments due.
  • Reviewed flagged items daily and resolved issues in accurate and efficient manner.
  • Processed refunds, disbursements and payments.
  • Compared statements against patient files.
  • Submitted electronic bills following facility and legal compliance standards.
  • Generated detailed reports outlining billing, flagged items and other important data.
Education and Training
Expected in 03/2009 | Business Administration And Management Murray State University , Murray, KY, GPA:

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  • Murray State University

Job Titles Held:

  • Credentialing Specialist
  • Medical Staff Coordinator
  • Patient Financial Representative


  • Some College (No Degree)

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