Credentialist Ii Resume Example

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Jessica Claire
  • Montgomery Street, San Francisco, CA 94105
  • H: (555) 432-1000
  • C:
  • Date of Birth:
  • India:
  • :
  • single:
Career Overview
Highly motivated Sales Associate with extensive customer service and sales experience. Outgoing sales professional with track record of driving increased sales, improving buying experience and elevating company profile with target market.
Core Strengths
Proficient in all Microsoft Office applications, including Outlook, PowerPoint, Word and Excel
Have been the team lead on a project that contacted providers in a large managed care network in order to verify demographic information, obtain updated copies of medical licenses and malpractice sheets.
Strived to meed weekly production of credentialing portfolios to be reviewed by quality assurance with a very low return rated.
Call Center
Answered calls in a call center with a very high call volume, taking between 75 to 90 calls a day.  Some days taking more calls. Resolving issues and assisting callers with questions.
Work Experience
Credentialist II, 07/2010 to Present
Southern Colorado Veterinary Internal Medicine Colorado Springs, CO,
  • Create and maintain credentialing portfolios for domestic and international medical and osteopathic physicians.
  • Provide scheduled updates to the physician regarding the status of the credentialing profile.
  • Assist in requesting and obtaining primary source verifications including but not limited to: medical school verification form, transcript and diploma; post graduate medical training verification forms; licensure examination scores (USMLE, NBME, NBOME, state boards, etc.) Compile and analyze all documents for discrepancy and completion to ensure documents and training meet the state board requirements.
  • Prior to the position of Credentialist II, I was employed in the Customer Service Department as a contract employee from February 2010 to July 2010.
  • In this position, I assisted physicians with completing applications, confirmed what documents needed to be submitted, provided status of process.
Client Service Representive, 04/2003 to 10/2009
Computer Science Corporation City, STATE,
  • The financial service group of Computer Science Corporation provides customer service for various life insurance companies.
  • This position involves answering phones, data entry, and either mailing or faxing forms to policyholders or agents.
  • Providing customer service to policyholders who call in, answering questions that they have about their policies.
  • Phone calls come through an ACD line and the call volume could be high.
  • Skills for this job include having excellent customer service, communication, organization and the ability to multi-task.
  • In 2007 began telecommuting thus proving an ability to further work with very little supervision and still maintain department service level agreements.
Provider Relations Coordinator/Administrative Support, 01/1994 to 03/2002
ValueOptions, INC City, STATE,
  • Provided support to the department director by conducting group interviews, checking references, and documenting paperwork on candidates.
  • Trained new department staff, ensured that they had access to the necessary computer systems.
  • Prepared reports and materials for meetings, reviews and audits with clients.
  • Participated in meetings with clients.
  • Preformed customer service to clients, providers and internal staff.
  • Organized and oversaw projects and distributed assignments to provider relations staff.
  • Updated database to reflect accurate demographic information.
  • Conducted training with other departments to explain functions and responsibilities of the Provide Relations Department.
  • Composed staff meeting agendas and meeting minutes.
  • Regional Team Lead of companywide project that contacted our contacted providers to verify demographic information, collected corrected documentation, and forwarded to the department that was inputting the data into the computer.
  • Assisted providers in resolving claims issues.
  • Contacted provider offices to conduct provider education regarding contractual obligations.
  • Created letter templates in MS Word and spreadsheets in Excel to do mail merges for mass mailings each month to obtain updated licensure, DEA/State Controlled Substance Licensures, Malpractice coverage form contracted providers and facilities.
  • Developed a training session to review the systems with the Provider Relations Staff.
  • Have both done initial credentialing and recredentialing of providers, creating files for documentation of the required information.
  • Contacted practitioners in recruiting efforts to develop provider networks in areas that needed additional coverage for patients/employees of our companies that hired ValueOptions to manage their mental health coverage.
Educational Background
Bachelor of Arts: English, Expected in
University of Texas - Arlington,
Paralegal courses: , Expected in
Tarrant County College - ,
ACD call center,  assisting clients, excellent customer service, data entry,  reviewing documentation, faxing forms, assisting policy holders with questions about life insurance policies, mailing documents,preparing minutes for  meetings,recruited physicians for a mental health managed care network, Computer Proficiency, Paralegal,Courses, met service level agreements, spreadsheets, supervision, 10-Key, Problem solving, Critical Thinking, Internet Research, Telephone Skills, Typing, Microsoft Excel, Outlook, Word.

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Resume Overview

School Attended
  • University of Texas
  • Tarrant County College
Job Titles Held:
  • Credentialist II
  • Client Service Representive
  • Provider Relations Coordinator/Administrative Support
  • Bachelor of Arts
  • Paralegal courses