Credentialing Support Specialist Full Time resume example with 14+ years of experience

Jessica Claire
, , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
Home: (555) 432-1000 - Cell: - - -
Professional Summary

Enthusiastic Credentialing Specialist eager to contribute to team success through hard work, attention to detail and excellent organizational skills and time management skills. Strong attention to detail, effective communication skills and solid history of tackling diverse and challenging requirements Motivated to learn, grow and excel in the Quality Management Department.

  • Highly Professional
  • Team Collaboration with NCQA and EQR Processes
  • Organizational Skills
  • Attention to Detail
  • Active Listening
  • Microsoft Windows and Office
  • Multitasking and Prioritization
  • Verbal and Written Communication
  • Collaborative Team Player
  • Time Management
  • Tracking and Documentation
Work History
03/2013 to Current
Credentialing Support Specialist- Full-Time Trillium Health Resources City, STATE,
  • Assist, as needed, in preparation of informational reports and/or special projects as requested by the managers and/or directors.
  • Learn the policy and procedures regarding Credentialing of providers and practitioners.
  • Prioritize and complete tasks in a timely matter. I currently meet all deadlines in an appropriate manner to avoid delays (time management)
  • Participate in audits, reviews and departmental and organizational projects, such as EQR and NCQA
  • Assist, as needed, in preparation of informational reports such as Monthly OIG Sanctions Report and Monthly National Practitioner Data Bank Report (NPDB) and/or special projects as requested by the managers and/or directors.
  • Receive and process emails/tickets from internal staff and external Providers with promptness.
  • Provide prompt technical assistance and support for both in- network providers and community stakeholders, as needed.
  • Ensure all Credentialing Program standards are adhered to and notify Manager of any concerns.
  • Represent Credentialing Committee by participating on Trillium committees as a non-voting member, various cross functional projects as well.
  • Develop Processes/Desktop Protocols to successfully transition to Tailored & Standard Plans.
  • Assist team in decreasing out of compliance scores/plan of corrections for the Credentialing unit by identifying problematic
    areas and find solutions to correct the problems.
  • Reviewing, understanding, and implementing EQR & URAC Standards and DMA Contract Elements. Assisted the Credentialing team with identifying problematic areas and find solutions to correct the problems.
  • Processed Agency Credentialing Applications to ensure Accreditation standards were met.
  • Current Experience and employment in the Managed Care Environment.
07/2007 to 02/2013
ACTT Team -office Manager-Full-Time Psychotherapeutic Services City, STATE,
  • Solved problems timely and effectively, ensuring customer satisfaction.
  • Streamlined office operations by computerizing activities, managing member communications, scheduling staff meetings and tracking records and documents, such as person-centered plans.
  • Received, screened and routed incoming calls.
  • Created, organized, and set up an information center for manuals, which resulted in Better access to needed information, and less time searching for it.
  • Participated in agency internal and external audits such as CARF.
  • Created and managed electronic patient recording, including data entry and administrative functions.
  • Developed highly-efficient administrative team through ongoing daily meetings and professional development opportunities.
  • Interacted with customers professionally by phone, email or in-person to provide information and directed to desired staff members.
  • Practiced Health and Safety protocols to decrease incidents in the workplace.
05/2006 to 06/2007
Qualified Mental Health Specialist-QP-Full-Time Bridges Of Hope,Inc. City, STATE,
  • Documented client progress in confidential files.
  • Facilitated group family meetings during treatment planning.
  • Communicated with clients to develop social and psychiatric observations.
  • Provided clients with recommendations to community resources.
  • Monitored patients and assessed suicide risks.
  • Encouraged clients to express feelings and discuss what was happening in day-to-day life in order to help each person develop insight into personal experiences and relationships
  • Mediated conflicts within families to clarify and resolve underlying issues.
  • Encouraged patients to discuss experiences in group and individual settings.
  • Worked collaboratively with other mental health professionals to provide consistent care and minimize diversion.
  • Provided comprehensive case management services, including creating treatment plans and connecting clients and families to appropriate resources.
  • Managed caseload of 20-25 patients with substance dependence and co-occurring Axis I and Axis II disorders.
  • Observed and monitored client behavior and responses to treatment.
  • Consulted with other staff members regarding treatment plans as deemed appropriate by team leader.
Expected in 05/2004
Bachelor of Arts: Psychology, Child Developmental and Family Relations
East Carolina University - Greenville,NC ,

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Resume Overview

School Attended

  • East Carolina University

Job Titles Held:

  • Credentialing Support Specialist- Full-Time
  • ACTT Team -office Manager-Full-Time
  • Qualified Mental Health Specialist-QP-Full-Time


  • Bachelor of Arts

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