Credentialing Specialist Resume Samples - Page 2

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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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11

Office Manager/ Credentialing Specialist

Completed provider enrollment applications and followed-up on the status of paperwork (Commercial Insurance carriers, Medicaid and Medicare )

  • Provided administrative assistance to the CEO, CFO, and Director of Operations.
  • Developed, drafted and reviewed office correspondences and forms
  • Accounts payable and receivable
  • Ordered office supplies
  • Planned/ organized office events/parties
  • Appealed denied claims
  • Followed-up on unresolved medical billing issues
Candidate Info
11
years in
workforce
1
year
at this job
12

Credentialing Specialist, Upi/triwest Provider and Institution Credentialing

Credentialed 5000+ UPI providers/Triwest Providers for 49 Managed Care Organizations that delegate the credentialing process to UPI.

  • Credentialed 500+ Institutions that delegate the credentialing process to UPI.
  • Performed criminal history checks for oncoming providers
  • Ran queries on providers for any monthly sanctions
  • Performed large mailings weekly
  • Developed flow charts detailing steps for oncoming or recredentialing providers
  • Composed file folders daily
  • Compose detailed check sheets
  • Extensively review physicians "Colorado Health Care Professional Credentials" application
  • Insert completed and reviewed criminal history/background checks
  • File completed files in high density filing system
Candidate Info
9
years in
workforce
9
years
at this job
AS
Science
Nursing Assistant
13

Credentialing Specialist

Screened and validated information given by providers

  • Verified information and credentials supplied by applicant
  • Created enrollment records in the Provider Enrollment Chain Organization System (Pecos)
  • Scanned electronic documents attaching them to correct files
  • Verbally responded to telephone and written inquires daily
Candidate Info
4
years in
workforce
1
year
at this job
HS
High School Diploma
14

Credentialing Specialist

  • Assisted in credentialing vision, dental, and hearing providers to company network which administers various managed care plans nationally that included Medicaid, Medicare, UPMC, and etc.
  • Frequent contact with vision and dental providers and practice managers to verify and obtain outstanding credentialing information including but not limited to Malpractice insurance policies, State Licenses, DEA certificates, and etc.
  • Updated multiple internal software systems with provider and practice information
  • Coordinated with supervisor to organize provider files for audit and HIPPA compliance purposes
  • Assisted in maintaining physical credentialed provider files
  • Scanned physical files to assist the departmental effort to transition to paperless records
  • Assisted in large data conversion project that consolidated multiple internal software systems to one dedicated application
Candidate Info
5
years in
workforce
3
years
at this job
HS
High School Diploma
BA
History
15

Credentialing Specialist

Reviewed and analyzed dental credentialing applications, ensuring completeness, accuracy and compliance with federal, state, and local accreditation agencies and company guidelines, policies and standards.

  • Queries National Practitioner Databank and Office of Inspector General and SAM on all prospective dental providers.
  • Organize and maintain credentialing files. Works with provider relations staff to ensure follow up when provider's applications are incomplete.
  • Assists with the coordination of the credentialing committee review.
  • Tracks Providers expiration dates, mail renewal documents and maintain records regarding providers liability insurance.
  • Initiates correspondence to providers and clients when necessary to obtain requisite credentialing and re-credentialing information.
Candidate Info
11
years in
workforce
4
years
at this job
AA
Associate of Arts
16

Credentialing Specialist

Maintain regular cooperation and compliance with all regulatory, accrediting, and membership-based organizations.

  • Create and carry out various credentialing processes in relation to physicians, medical assistants, and various other healthcare professionals.
  • Ensure that all personnel and services adhere to facility and staff policies, department guidelines, regulations, and government laws.
  • Process applications and reappointment paperwork, checking for full completeness and accuracy.
  • Constantly collect and process significant amounts of verification and accreditation information
  • Must constantly maintain and update accurate databases for both practitioners and facilities.
  • Prepare their own records for regular auditing.
  • Maintain close communication with all appropriate practitioners to ensure that records are up-to-date and consistent.
Candidate Info
6
years in
workforce
5
months
at this job
HS
High School Diploma
Medical Insurance
17

Credentialing Specialist

Coordinate and monitor the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.

  • Conduct thorough background investigation, research and primary source verification of all components of the application file.
  • Identify issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
  • Respond to inquiries from other healthcare organizations and clients on a day-to-day basis, regarding credentialing and privileging issues as they arise.
  • Utilize the Cactus credentialing database, optimizing efficiency, run reports; submit and retrieve National Practitioner Database reports in accordance with Health Care Quality Improvement Act.
  • Ensured compliance with regulatory bodies (Joint Commission, NCQA, CMS, federal and state), as well as Medical Staff Bylaws, Rules and Regulations, policies and procedures, and delegated contracts.
  • Work effectively with other departments to ensure proper payment and claims processing.
  • Contact all appropriate parties to obtain, verify and validate correct claim information claims by telephone, fax, email, and/or mail to resolve unpaid and denied claims with minimal errors.
Candidate Info
15
years in
workforce
2
years
at this job
Medical
18

Credentialing Specialist

Complete hospital and DOD applications for appointment and the reappointment process

  • Complete Medicare applications as needed for the client and [company name]
  • Submit soft credentials to our clients, as needed for the Radiologists
  • Prime Source Verify the Radiologists credentials.
  • Completed hospital and DOD applications for appointment and the reappointment process
  • Completed Medicare applications as needed for the client
  • Submitted soft credentials to our clients, as needed for the Radiologists
  • Prime Source Verified the Radiologists credentials.
Candidate Info
16
years in
workforce
5
years
at this job
AS
Medical Assisting
19

Credentialing Specialist

Process re-credentialing applications and paperwork using CAQH database

  • Check for full completeness and accuracy
  • Collect and process significant amounts of verification and accreditation information
  • Maintain and update accurate database for both practitioners
  • Check and maintain pertinent education, training, experience and licensure content. Credentialing Maintain close communication with all appropriate practitioners to ensure that records are up-to-date and consistent
  • Answer calls from providers regarding credentialing application status and credentialing criteria.
  • Train new Administrative Assistant and Data Entry staff
Candidate Info
10
years in
workforce
3
years
at this job
English
English
20

Credentialing Specialist

Assist in the implementation of a centralized system-wide credentialing program

  • Develop, mail, collect, and process reappointment credentialing applications for the health system
  • Communicate directly with physicians, allied health staff, and office managers regarding reappointment
  • Notify medical staff when state licenses and malpractice insurance certificates on file will expire
  • Collaborate with medical staff coordinators at all five St. Vincent's Health System entities
Candidate Info
10
years in
workforce
2
years
at this job
AS
Arts
BS
Human Development & Family Studies

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