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provider credentialing specialist remote resume example with 11+ years of experience

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

Productive Credentialing Specialist/ Contract Negotiator with excellent skills in customer service, office management, and administrative support. Self-motivated Individual offering a concrete background in Healthcare Management/ Network Development. Great leadership abilities and dynamic team performer. Remains professional and tactful in all situations with focus on increasing satisfaction and retention. Versed in credentialing healthcare facilities and providers, conducting application reviews and verifications. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.

Skills
  • Customer Service Management
  • Analytical and Critical Thinking
  • Verbal and written Communication
  • Project Support
  • Time Management
  • Practitioner Credentialing
  • Contract Negotiation
  • Problem-Solving
  • Microsoft Office Proficient
  • Facility Credentialing
  • Organizational Development
  • Multitasking
  • Provider Relations
Experience
03/2022 to Current
Provider Credentialing Specialist - REMOTE The University Of Vermont Medical Center Inc Malone, NY,
  • Performed primary source verifications such as criminal histories, licenses and board certifications.
  • Assisted with enrolling physicians with Medicare, Medicaid, Blue Cross and Blue Shield, and various other insurance companies.
  • Completed enrollments into Medicaid, Medicare and private insurance plans.
  • Compile data into systems of record in an accurate, complete, and timely manner.
  • Setup providers and networks in systems of record, assign provider numbers, and communicate with provider community.
  • Engage and secure contracts, update and maintain license, Malpractice and DEA registrations as necessary for providers.
  • Processed documents and status-change requests, conducting followup assessment regarding enrollment inquiries.
05/2021 to 11/2021
Credentialing Analyst- REMOTE Performance Food Group La Vergne, TN,
  • Maintained informational resources, tracking and documenting requests for updates, certification, and credentialing.
  • Conducted primary source verifications such as background checks and board certifications.
  • Enrolled providers into Medicaid, Medicare, and private insurance plans.
  • Collected and analyzed information to monitor compliance outcomes and identify and address trends of non-compliant behavior.
  • Responsible for maintaining and adding current and accurate data for all providers.
  • Completes provider licensing applications and state renewal applications as needed.
  • Completes providers credentialing and re-credentialing applications and monitors and follows up as needed and documents progress on daily basis.
  • Received and evaluated applications to look for missing and inaccurate information.
12/2019 to 01/2021
Provider Relations Advocate- REMOTE League Of Southeastern Credit Unions Oglethorpe, GA,
  • Fostered strong, positive relationships with key providers by coordinating, facilitating, and leading partnership meetings and identifying on-site enrollment opportunities
  • Investigated concerns such as billing and claims questions on behalf of providers
  • Managed provider relations mailbox by triaging inquiries, facilitating resolution of incoming requests, and forwarding requests to appropriate parties.
  • Assisted with physician recruitment by identifying specific providers within designated territories, negotiating rates for new physicians, and distributing provider agreements, successfully recruiting 50 new physicians per year as a goal.
  • Identified network gaps and collaborated with senior manager to fill deficiencies.
  • Eliminated contractual risks by instructing providers and coordinating educational material distribution
  • Gathered, organized, and input information into digital database
  • Helped implement training and development of external providers through education programs
  • Initiated physician and hospital orientations to support ongoing education of health care provider community
  • Fostered strong, positive relationships with key providers by coordinating, facilitating, and leading partnership meetings and identifying on-site enrollment opportunities
  • Displayed strong telephone etiquette, effectively handling difficult calls.
09/2016 to 12/2019
Network Development Coordinator SPNet Clinical Solutions/ SPNet Medical, Inc City, STATE,
  • Partnered with business teams and IT personnel to align project goals with business strategy and define project milestones.
  • Produced reports, spreadsheets, and trend forecasts to enhance decision-making processes.
  • Spearheaded entire onboarding and orientation process for new employees, providing education and information to facilitate learning and improve employee job satisfaction.
  • Negotiate single case agreements and rates with providers as directed by senior management.
  • Help Director of Contracting to work to establish long term contracts with network facilities for new providers that are obtained by the company.
  • Participated in brainstorming sessions and team meetings to identify deficiencies and recommend changes to policies and procedures.
  • Provided responses to providers inquiries and or complaints to ensure open communication and prompt resolution of provider issues.
  • Research potential network participants to assist with development of state, regional, and national networks as directed by senior management.
06/2013 to 07/2016
Contracts Coordinator Magnolia Health- Centene Corporation City, STATE,
  • Monitored all incoming contracts and service agreements for correct pricing and information.
  • Coordinated and attended meetings as company's main contact to review contractual obligations.
  • Provide support to contract negotiators to ensure successful completion of the contracting process for the providers.
  • Managing existing contracts while seeking additional entities to expand company profits.
  • Checked information in company's database for accuracy and updated data with current information to maintain records.
  • Creates contracts and manages the contracting process unitizing the Emptoris Contract Management System to ensure that the new business contract deadlines are met.
  • Review final contracts before they are sent out to each provider that joins within the network.
  • Submitted project closeout documents in accordance with contract terms.
12/2010 to 02/2013
Contract Management Analyst NaphCare, Inc City, STATE,
  • Reviewed proposed contracts against established policies, guidelines, and legal requirements to identify critical issues.
  • Worked collaboratively with administrative staff in negotiation, correspondence, documentation, and compliance checks for service contracts.
  • Developed and followed processes to manage contracts and remain in compliance with company commitments and regulatory obligations.
  • Developed comprehensive medical service contracts with hospital, surgery centers, long-term care facilities, physicians, etc.
  • For inpatient, outpatient, and onsite services for Federal Correctional Facilities.
  • Negotiate competitive reimbursement Medicare/Medicaid rates with hospitals and specialists to meet cost containment needs.
  • Process claims at negotiated rates to fulfill cost containment needs, for the Federal Prisons we maintained.
  • Maintain positive, professional relationships with current participating providers.
Education and Training
Expected in 01/2008 to to
Bachelor of Science: Health Services Administration
University of Alabama At Birmingham - Birmingham, AL
GPA:
Expected in 01/1999 to to
Associate of Applied Science: Applied Science
SPNetSPNetBevill State Community College - Sumiton, AL
GPA:

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Resume Overview

School Attended

  • University of Alabama At Birmingham
  • SPNetSPNetBevill State Community College

Job Titles Held:

  • Provider Credentialing Specialist - REMOTE
  • Credentialing Analyst- REMOTE
  • Provider Relations Advocate- REMOTE
  • Network Development Coordinator
  • Contracts Coordinator
  • Contract Management Analyst

Degrees

  • Bachelor of Science
  • Associate of Applied Science

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