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Payer Enrollment Credentialing Specialist Resume Example

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Jessica Claire
, , 100 Montgomery St. 10th Floor
Home: (555) 432-1000 - Cell: - resumesample@example.com - -
Summary

Knowledgeable Credentialing Specialist brings knack for performing successful application checks and verifying informational resources. Nearly 3 years of experience overseeing data access and security based on up-to-date trends and standards. Adept at verifying primary sources and access-level tiers. Proven communicator and relationship builder expertly tracks complex update, certification and credential requests.

Skills
  • Facility credentialing
  • License verifications
  • Community health center credentialing
  • Application management
  • Insurance procedures
  • Personnel engagement
  • Affirmative action
  • Computer skills
  • Microsoft Office
  • Knowledgeable in Echo OneApp & Epic
  • Technologically-savvy
  • Applicant support and service
  • Recordkeeping and data input
Experience
09/2020 to Current
Payer Enrollment Credentialing Specialist Purdue University Dubois, IN,
  • Complete Payer Enrollments with BHSG for all BMG providers.
  • Complete Applications for Hospital Privileges for all BMG providers.
  • Maintain CAQH.
  • Complete all verifications as needed in regards to provider history.
  • Maintain Reappointment's & Re-Credentialing.
  • Epic Workque Assignments.
  • Echo OneApp Profile Maintenance
  • Assist Coordinators as needed in the onboarding process when new providers are assigned.
  • Maintain informational resources, tracking and documenting requests for updates, certification and credentialing.
  • Check applications for missing information and organized all paperwork.
  • Address credentialing requests, overseeing compliance with governmental and organizational guidelines regarding tiered data access.
  • Confirm facility and user credentials to initiate and maintain registration and enrollment processes.
  • Process documents and status-change requests, conducting followup assessment regarding enrollment inquiries.
  • Provide insight regarding job duties to optimize productivity.
07/2018 to Current
Payer Enrollment Credentialing Coordinator Baptist Memorial Medical Group, Inc City, STATE,
  • Skills.
  • Credential multiple Onboarding Providers for payer enrollment by utilizing critical thinking skills to complete the credentialing process.
  • Verifications to include but not limited to: Education, Employment, AMA, AOA, PDC, NPDB, ECFMG, Liability, Loss Runs, Licenses, DEA’s, NPI’s by thorough research via email, phone calls, and the internet.
  • Maintain and create multiple CAQH Profiles on behalf of each provider throughout the onboarding process.
  • Apply & renew for all provider DEA’s as needed.
  • Renew License’s for MS providers as needed.
  • Assist Specialists with phone calls to payers verifying issues regarding enrollment.
  • Shadow Specialists as time allows to understand job duties per payer.
  • Assist with other projects as needed individually & as a team.
  • Kept close tabs on documentation expiration dates, communicating with correct personnel to submit files prior to expiration.
  • Maintained informational resources, tracking and documenting requests for updates, certification and credentialing.
01/2017 to 06/2018
Business Assistant Audubon Dental Group City, STATE,
  • Provided excellent customer service and patient care.
  • Created financial arrangements and payment agreements for patients.
  • Accounts Receivable/Payable
  • Patient Account Auditing
  • Finance & Insurance Aging Reports
  • Billing & Collections
  • Insurance claims, EOB’s, narratives, verification, identify & maintain credentials with payers on provider behalf, escalations as needed.
  • Marketing via social media
  • Internal/Eternal email communication
  • Scheduling – Maintain patient appointments & ensure scheduled appointments were coded correctly prior to appointment.
  • Managed productivity through efficient scheduling, task prioritization and process streamlining.
  • Created and maintained filing systems by organizing and adding files.
05/2014 to 11/2016
Front Office Finance, Insurance Specialist Higginbotham Family Dental City, STATE,
  • Provide excellent customer service and patient care.
  • Ensure front office ran efficiently
  • Patient Liaison
  • Trained all front office staff
  • Created financial arrangements and payment agreements for patients.
  • Accounts Receivable/Payable
  • Patient account auditing
  • Billing & Collections
  • Finance & Insurance Aging Reports
  • Insurance claims, EOB’s, narratives, verifications, identified enrollment issues & escalated to external insurance department
  • Marketing via social media & in office
  • Internal/eternal email communication
  • Scheduling – Maintain patient appointments & ensure scheduled appointments were coded correctly prior to appointment.
  • Maintained impeccable office organization to support efficiency, professionalism and performance objectives.
  • Fostered relationships with patients to expand patient base and retain business.
Education and Training
Expected in
Diploma:
Arkansas State University - Jonesboro, AR
GPA:
Expected in
:
Stuttgart High School - Stuttgart, AR
GPA:
References
References upon request

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Resume Strength

  • Length
  • Personalization
  • Strong Summary
  • Target Job

Resume Overview

School Attended
  • Arkansas State University
  • Stuttgart High School
Job Titles Held:
  • Payer Enrollment Credentialing Specialist
  • Payer Enrollment Credentialing Coordinator
  • Business Assistant
  • Front Office Finance, Insurance Specialist
Degrees
  • Diploma

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