LiveCareer-Resume

senior credentialing compliance specialist resume example with 5+ years of experience

JC J S S JS J S S JS J S S JS J S S JS J S S JS J S S JS
Jessica Claire
Montgomery Street, San Francisco, CA 94105 (555) 432-1000, resumesample@example.com
Professional Summary

Adept Medical Staff Professional with over 10 years in provider credentialing services in various settings. Highly organized and detail-oriented with in-depth knowledge met by continuous learning and industry association involvement. Excellent reputation for being detail-oriented team player with strong organizational and research skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.

Skills
  • Provider Relations
  • Application coordination
  • Facility/Administrative support
  • Start up & Remote experience
  • Regulatory requirements
  • Documentation and reporting
  • Verbal and written communication
  • Organization skills
  • Deadline-oriented
  • Efficient multi-tasker
Work History
01/2021 to Current Senior Credentialing & Compliance Specialist Francisan Health | West Lafayette, IN,
  • Direct and implement strategic improvement plans to integrate solutions to audit findings and workflow processes. Collaborate with implementation, legal and product development teams to achieve best possible solution.
  • Serve as subject matter expert by creating and maintaining compliance and credentialing slab reference documents, monitoring operation team credentialing channel.
  • Collaborate with internal and external stakeholders, auditors and legal counsel to confirm compliance with applicable laws and regulations. Enforce credentialing compliance with regulatory standards, federal and state laws to prevent revenue loss, protect patients and mitigate lawsuits/reputational damage.
  • Monitor company compliance as it relates to facility requirements by performing various contract and workflow audits. Present findings to leadership, contract and legal teams.
  • Research new regions to ensure all state requirements are addressed in contract and carried out during onboarding.
  • Collaborate with various departments to generate new ideas to implement, improve and simplify application for end users.
  • Mentor new hires, resulting in stronger staff development and increased productivity. Prepared and presented supplementary learning material to support structured lessons.
  • Championed re-evaluating vendor contracts ultimately decreasing Color Blind Testing costs by 75 percent and state specific background check cost by 25 percent.
08/2020 to 01/2021 Lead Credentialing Specialist Ahmc Healthcare Inc. | Anaheim, CA,
  • Reviewed provider applications to look for missing and inaccuracies. Followed up with provider or practice to collect additional information.
  • Performed primary source verification in accordance to regulatory standards. Continuously monitored expiring credentials to make certain providers were compliant with requirements.
  • Participated in weekly Medical Staff meetings to discuss processed files, red flags and review outcomes prior to department chair or committee review.
  • Collaborated with various team members and departments to complete credentialing and privilege applications under strict onboarding deadlines.
  • Maintained database by updating application statuses, assign approved privileges and notifying providers of committee decisions.
  • Assisted providers with adding or removing privilege requests.
  • Managed on average 50 provider applications for initial or re-appointment monthly.
10/2019 to 08/2020 Credentialing Program Assistant Veterans Administration EKHCS | City, STATE,
  • Completed credentialing process for providers applying for initial/reappointment. Ensured credentialing accuracy by collecting all required documentation/information requested and completing follow up correspondence if needed.
  • Processed applications according to facility, state, federal and other regulatory body regulations.
  • Monitored expiring licenses to include DEA, COI, Professional Licensure and Board Certifications. Reviewed OG/SAM sanction queries, NPDB and performed Education verifications.
  • Participated in continuous improvement by spearheading new department workflows decreasing application turn around times and meet reappointment cycle deadlines.
  • Reduced application completion times 50% by developing and implementing electronic applications to email to providers.
  • Managed both digital and physical filing systems and retrieved documents as required.
  • Drafted agendas, recorded minutes and generated documents to facilitate meetings.
  • Managed government purchase card recording and balancing department and credentialing verification purchases.
08/2017 to 10/2019 Credentialing Coordinator St. Luke's Cushing Hospital | City, STATE,
  • Under minimal supervision, followed procedures for appointment and clinical privileges as outlined in Bylaws, Policies and Procedures, Rules and Regulations.
  • Independently performed primary source verifications of documentation required for initial credentialing and reappointment applications through sources such as National Practitioner Data Bank (NPDB) and applicable Medical Boards.
  • Collected research, analyzed data and information from key stake holders to support new privilege development.
  • Identified red flags, potential issues and/or processing delays related to provider credentialing applications. Communicated issues with appropriate parties and obtained clearance from legal and/or entity representatives as appropriate..
  • Communicated professionally in both verbal and written form to applicant, corporate staff, and external agencies. Performed timely follow-up on required information (expired licenses, board certifications, insurance, DEA registrations, and other documents).
  • Managed Medical Staff committee meetings which included organizing, scheduling, creating agenda packets, coordinating catering, media services and taking meeting minutes.
  • Prepare, disseminate and maintain physician’s emergency department and anesthesia department call schedules.
  • Participated in Joint Commission Survey and readiness sweeps.
Education
Expected in 05/2024 to to Bachelor of Applied Science | Health Sciences Southwestern Oklahoma State University, Weatherford, OK, GPA:
Expected in 05/2010 to to Associate of Applied Science | Medical Staff Services Management National American University, Kansas City, MO, GPA:
Affiliations

National Association Medical Staff Services

Oklahoma Association Medical Staff Services

Certifications

Certified Provider Credentialing Specialist (CPCS)


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

Your data is safe with us

Any information uploaded, such as a resume, or input by the user is owned solely by the user, not LiveCareer. For further information, please visit our Terms of Use.

Resume Overview

School Attended

  • Southwestern Oklahoma State University
  • National American University

Job Titles Held:

  • Senior Credentialing & Compliance Specialist
  • Lead Credentialing Specialist
  • Credentialing Program Assistant
  • Credentialing Coordinator

Degrees

  • Bachelor of Applied Science
  • Associate of Applied Science

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

*As seen in:As seen in: