Credentialing Specialist Resume Samples

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Credentialing Specialists are responsible for verifying the professional licenses and certifications of medical staff. Their duty is making sure that federal and state standards are met and they may also assist auditors and help keeping a facility's accreditation. The strongest example resumes for Credentialing Specialists emphasize health information expertise, organization, attention to details, teamwork and communication skills. Report writing skills are a must. Most sample resumes for Credentialing Specialists highlight an Associate's Degree in health information management.

For more information on what it takes to be a Credentialing Specialist, check out our complete Credentialing Specialist Job Description.

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1

Senior Credentialing Specialist

Processed provider credentialing information, including verification of data in accordance with policies and procedures, to support network development and credentialing processes.

  • Assisted in preparing and coordinating provider information to / from managed care quality committees and other internal departments and / or external entities.
  • Exceeded production goals by 99% while maintaining quality.
  • Maintained credentialing database while tracking all direct provider contract data.
  • Performed primary and secondary source verifications of credentials according to departmental policy.
  • Maintained all medical license, Drug Administration and malpractice insurance for physicians and mid-level providers.
  • Ensured compliance with national standards of quality organizations.
Candidate Info
33
years in
workforce
14
years
at this job
HS
Business
AAS
Accounting
2

Credentialing Specialist I

Supervised Payor Audits

  • Audited, data entered, and preformed primary source verifications in accordance with various regulatory agencies for credentialing, recredentialing, and delegated accounts.
  • Resolved practitioner concerns in a timely manner.
  • Analyzed reports to ensure processing compliance.
  • Produced canned reports and maintained Visual Cactus Database
Candidate Info
15
years in
workforce
4
years
at this job
Business Administration
3

Credentialing Specialist

Exceeded performance standards

  • Promoted special projects to enhance operations
  • Efficiently credentialed all initial applicants in a timely fashion
  • Supported enterprise decision-making with subject matter expertise
  • Provided excellent customer service to practitioners, managers and teams as evidenced by satisfaction surveys
Candidate Info
18
years in
workforce
11
months
at this job
BS
Education
4

Lead Credentialing Specialist

Assessed applicant skills and abilities to confirm suitability and make appropriate position matches for government contracts. Coordinated with administrative points of contact in each staff element to ensure pool of applicants matched open needs.

  • Provided assistance and guidance to employees with resume preparation, health record requirements, and completion of the personal provider information sheet (PPIS), and SF85P forms.
  • Provided written and verbal instructions throughout each step of the credentialing process.
  • Performed primary source verification of provider credentials, education, and employment history.
  • Conducted electronic queries using databases for verification and sanction information for the credential file and contract application. Researched salaries for salary survey and comparison.
Candidate Info
8
years in
workforce
3
years
at this job
HS
High School Diploma
C
Pharmacy Tech
BS
Business
5

Credentialing Specialist, Office of Medical Staff Affairs

Managed credentialing process for initial appointments and reappointments of medical staff working closely with department chairmen, faculty, and hospital administrators

  • Increased productivity and improved efficiency by systematizing and creating a performance improvement plan for the re-credentialing process
  • Lead the transition from paper to electronic application submission (in process)
  • Verified the professional licensing, training, and certifications of professional medical staff to ensure healthcare professionals comply with all established regulations and guidelines
  • Assisted in interpretation and enforcement of Medical Staff Bylaws and Joint Commission standards and provide guidance to Medical and Dental Staff when necessary
  • Maintained and updated all practitioner databases
  • Reviewed credentials files and ran reports for potential red flags
  • Assisted in areas of budgeting, performance improvement, and compliance as needed
  • Attended monthly Medical Executive Committee, Credentials Committee, and Quarterly Medical Staff Meetings with hospital administrators as required
Candidate Info
23
years in
workforce
2
years
at this job
C
Conflict Resolution
BS
Public Health Administration
MBA
Strategic Healthcare Management
6

Credentialing Specialist

I began this position without any knowledge after only being there for 6 months the other Credentialing Specialist gave her 2 weeks notice. At that point of time I took over and continue to be the only credentialing specialist for 9 different hospitals.

  • I don't hold any certificates at this time, partly because I needed to have at least 2 years of experience in the field and once I had the 2 years of working knowledge I was so busy and continue to busy but I am willing to get certified.
  • I am a member of NAMSS.
  • At this time I currently do all aspects of credentialing for over 500 providers at 9 different hospitals.
  • I prepare the Credentialing Agenda, Credentialing Report and provide the minutes for the Credentialing monthly meeting.
  • I provide the Orientations for all new providers.
  • Credentialing Software - Midas/Series
Candidate Info
14
years in
workforce
4
years
at this job
7

Credentialing Specialist

Enhance and conduct onboarding process for all new hires (Physicians, Nurse Practitioners, Physician Assistants and Scribes)

  • Coordinate, manage, and maintain Scribe onboarding for the team
  • Develop process improvement initiatives to improve operational efficiency and reduce onboarding turn over time
  • Collaborate with new hospital clients and establish processes to facilitate onboarding for new hires by a strict deadline
  • Generate and deliver onboarding process reports for hospital management by providing status updates on new hires
  • Build and manage relationships with hospital clients, recruiting and physician leadership
  • Developed and implemented onboarding workflows, hospital requirements paperwork, and best practices for onboarding team
  • Received three "MedAmerica: All Star" awards for demonstrating accountability, providing exceptional service, teamwork and camaraderie
Candidate Info
5
years in
workforce
2
years
at this job
BS
Health Services Management
MS
Healthcare Administration
8

Credentialing Specialist

Coordinate the credentialing process for a staff of 30 pathologists. Monitor and renew medical licenses and malpractice insurance.

  • Execute applications and track the process for new State medical licenses for providers.
  • Collaborate with insurance companies and process enrollments into Medicare and MassHealth.
  • Maintains appropriate CME requirements for each State license for individual physicians.
  • Resolve contracting issues with credentialing and continually initiate system and process improvements.
  • Verify State licenses, Board Certificates using the National Practitioner Data Bank Report, online verification of medical licenses, Veridoc, Federation of State Medical Boards, Uniform License Application.
Candidate Info
10
years in
workforce
1
year
at this job
BS
Education
MA
Hr Management
9

Credentialing Specialist

Meet with Providers to discuss contracting and insurance requirements for participation with each insurance company.

  • Prepare and submit all appropriate applications and required supporting documentation.
  • Follow-up with insurance companies to insure timely processing of applications and contracts.
  • Educate providers on credentialing and contracting guidelines and requirements
  • Facilitate monthly and or weekly meetings with insurance provider representatives to insure escalated issues are handled and resolved in a timely manner.
  • Run daily production and task inventory, discuss with management appropriate course of action to maintain work load and productivity requirements.
Candidate Info
15
years in
workforce
11
months
at this job
Business Management
10

Credentialing Specialist

Promoted to Credentialing Analyst for largest client as a specialist.

  • Worked within a specialized team to maintain provider profiles for over a thousand healthcare providers, as well as new enrollments for healthcare providers new to the system.
  • Created a system to maximize workflow and communication within the team to increase efficiency, output, and quality of service by establishing new guidelines and procedures.
  • Assisted in managing accounts by maintaining client relations and performing routine checks and audits for oversight.
Candidate Info
2
years in
workforce
1
year
at this job
BA
Political Science

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