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credentialing specialist resume example with 5+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
  • :
Summary

Healthcare administrative professional dedicated to working quickly and accurately to perform diverse administrative functions and achieve targets. Positive and upbeat team player with good communication, organizational and time management abilities. Adept at handling simultaneous tasks.

Skills
  • Communication
  • Problem solving
  • Time Management
  • Team Work
  • Organization
  • Decision-making
  • Microsoft Office
  • Multitasking
  • Reliable and trustworthy
Experience
Credentialing Specialist, 04/2019 - Current
 Hospital Sisters Health System - Corporate – Eau Claire, WI,
  • Supports the credentialing and recredentialing processes for applicants and members of the Medical Staff and Allied Health Professionals throughout Baptist Health South Florida.
  • Initial applications and reappointment applications are processed in accordance with established policies, rules and regulations, bylaws, and regulatory governmental standards and NCQA standards, thereby ensuring that only qualified practitioners provide care within BHSF.
  • In collaboration with each Medical Staff office, professionally supports health care providers in verifying their credentials and obtaining appropriate privileges.
  • Participates in projects initiated to facilitate the credentialing and verification process.
  • Function under close supervision of department leadership and participation in educational opportunities.
Rehab Project Coordinator, 06/2017 - 04/2019
 Ardent Health Services – Pocatello, ID,
  • Coordinate, collect, organize, and scan Rehabilitation Services data.
  • Faxes/mails/receives and monitors Plan of Care for evaluations, re-evaluation, and additional treatment.
  • Responsible for tracking any I completed Plan of cares I receive and contacting appropriate physician o ces and families.
  • Prepare and maintain logs and databases for POCs, charges, and transfers using Treatment Queues in PEDS.
  • Reconcile charges and monitors the correction of any missed charges.
  • Responsible for the discharge process of patient accounts.
  • Assists therapists with patient care activities with direct supervision as needed.
  • Make sure we are maintaining an environment of care for designated equipment and keep the treatment area clean and organized.
  • Coordinate care of Early Steps patients through continued process and monthly maintenance of required documentation.
  • Assists manager with appointments/meetings as need.
  • Counted inventory, resolved discrepancies and completed paperwork to keep system accurate and current.
  • Integrated process improvements to increase overall workflow.
  • Developed and monitored weekly staff schedules.
  • Kept work flowing smoothly in and out of department by working closely with management and patient access registrars.
  • Collaborated with cross-functional teams to draft project schedules and plans.
  • Set project goals and schedule with team members.
  • Prepared presentations for customers and staff members detailing project scope, progress and results.
  • Implemented procedural updates to correct deficiencies and improve operations.
  • Documented patient interactions in compliance with HIPAA requirements.
  • Provided support to department by assisting with special assignments and projects.
  • Identified key issues regarding workflow processes by assisting therapists with quality reviews.
  • Planned and executed compliance audits to check company policies, procedures and controls.
  • Maintained and revised policy procedures for general operation of compliance program.
Registrar, 02/2016 - 06/2017
 One Medical – Walnut Creek, CA,
  • Greets patients and families in person and on telephone showcasing.
  • Answered questions and fulfilled requests with friendly and knowledgeable service.
  • Collected, evaluated and stored documents securely in permanent records.
  • Proofread documents carefully to check accuracy and completeness of all paperwork.
  • Ordered and restocked supplies in line with budget limits and office needs.
  • Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
  • Verified that patients had proper insurance coverage prior to procedures or appointment scheduling.
  • Updated patient and insurance data and input changes into company computer system.
  • Checked documentation for appropriate coding, catching errors and making revisions.
  • Identified important patient and demographic information.
  • Assisted 100 patients weekly by reviewing personal cases and insurance coverage information.
  • Created and maintained accurate and confidential patient files according to regulatory mandates.
  • Maintained office supplies inventory by checking stock and ordering new supplies as needed.
  • Prepared new charts, updated existing charts and managed records transfers between offices.
  • Managed front office customer service, appointment management, billing and administration tasks to streamline workflow.
  • Adhered to HIPAA requirements to safeguard patient confidentiality.
  • Managed incoming telephone calls, including taking messages and directing callers to personnel.
  • Communicated with patients to gather intake data and verify chart information.
  • Helped patients complete paperwork and explained processes and procedures.
Administrative Assistant, 03/2012 - 03/2016
 Good Shepherd Hospice – Tulsa, OK,
  • Organized and maintained filing and document management systems by coordinating, archiving and purging files.
  • Developed administrative processes to achieve organizational objectives and improve office efficiency.
  • Handled management of communication to executives by taking and making telephone calls, reviewing and prioritizing mail and composing and typing correspondence.
  • Updated details in company database by keying in customer contacts and delivery dates.
  • Maintained inventory in supply closet to prevent shortages.
  • Directed customer communication to appropriate department personnel.
  • Prepared packages for shipment by generating packing slips and setting up courier deliveries.
  • Oversaw daily collections and accounts receivable activities, developing robust strategies to maximize collections and reduce aged accounts.
  • Identified discrepancies and carrier issues regarding billing and reimbursements.
  • Sent incomplete or incorrect claims to supervisors for proper adjudication.
  • Took billing calls, questions and concerns from patients and third party carriers.
  • Entered patient charges and payments into electronic health records.
  • Processed refund requests and reconciled deposit and patient collections.
  • Answered phone calls, responding to basic questions regarding appointments and clinic operations and directing calls within clinic as appropriate.
  • Applied HIPAA privacy and security regulations while handling patient information.
  • Posted charges, payments and adjustments.
  • Filed and submitted insurance claims.
  • Prepared and submitted claims to insurance companies electronically and manually.
  • Completed and submitted appeals for denied claims.
  • Reviewed patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under policies.
  • Posted and adjusted payments from insurance companies.
Surgical Coordinator, 11/2011 - 03/2012
 Agility – Queens, NY,
  • Checked patient insurance and collected pre-authorizations from providers.
  • Worked with operating facilities to schedule procedures on behalf of 10 opthalmology and plastic surgeons.
  • Gathered current medical information and reviewed histories to gather details for surgeons.
  • Distributed treatment and procedural information to patients.
  • Managed patient check-in and check-out procedures and processed payments.
  • Scheduled follow-up appointments as designated by physician.
  • Coordinated work processes and routed paperwork to appropriate physicians and staff members.
  • Collaborated and established strong working relationships with physicians, supervisors and colleagues.
  • Located scheduling barriers and implemented appropriate solutions.
  • Booked surgeries according to physician volume and maintained prompt turnaround times.
  • Arranged and scheduled post-operative visits during appropriate timeframe after surgery.
  • Obtained signatures and collected completed pre-operative consent and HIPAA forms from patients.
  • Answered phones, greeted patients and filed paperwork to maintain smooth operations in front office.
  • Informed patients of payment policies, collected insurance information and verified benefits.
  • Collected coinsurance and deductible payments prior to procedure date.
Receptionist, 10/2010 - 03/2011
 Marin Foot And Ankle – City, STATE,
  • Scheduled and confirmed appointments.
  • Answered and directed incoming calls using multi-line telephone system.
  • Delivered administrative support to team members by making copies, sending faxes, organizing documents and rearranging schedules.
  • Maintained daily calendars, set appointments with clients and planned daily office events.
  • Sorted incoming mail and directed to correct personnel each day.
  • Oversaw office inventory by restocking supplies and submitting purchase orders.
  • Screened and verified visitors for identification credentials and purpose of visit to maintain security of personnel and office environment.
  • Maintained financial records to verify timely clearance of credit and debit activities.
  • Managed more than 50 incoming calls per day.
  • Entered insurance, demographics and health history into patient database.
  • Checked patients in and out for appointments and collected co-payments.
  • Called patients to confirm scheduled appointments and obtain additional details.
  • Scheduled and followed up on patient appointments, collected and processed patient payments and maintained patient files.
  • Protected patients by observing strict HIPAA guidelines.
  • Processed patient payments and scanned identification and insurance cards.
  • Photocopied insurance cards, documented details and verified patient coverage for upcoming procedures or appointments.
  • Took messages from patients and promptly relayed to appropriate staff.
  • Greeted each patient pleasantly and offered desk sheet for easy sign-in.
  • Answered multi-line phone system and directed callers to requested personnel and departments.
Education and Training
Master Degree: Business Administration, Health Care Administration, Expected in 09/2021
-
Keiser University - Ft. Lauderdale, FL
 GPA:
Status -
Bachelor’s Degree: Health Care Administration, Expected in 04/2017
-
Keiser University - Ft. Lauderdale, FL
 GPA:
Status -
Associate’s Degree: Health Care Administration, Expected in 10/2011
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Keiser University - Ft. Lauderdale, FL
 GPA:
Status -
Diploma: , Expected in 06/2009
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Hialeah Senior High School - Hialeah, FL
 GPA:
Status -

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Resume Overview

School Attended

  • Keiser University
  • Keiser University
  • Keiser University
  • Hialeah Senior High School

Job Titles Held:

  • Credentialing Specialist
  • Rehab Project Coordinator
  • Registrar
  • Administrative Assistant
  • Surgical Coordinator
  • Receptionist

Degrees

  • Master Degree
  • Bachelor’s Degree
  • Associate’s Degree
  • Diploma

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

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