Credentialing Specialist Resume Samples - Page 5

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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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41

Provider Enrollment and Credentialing Specialist

Confirming provider's information with accrediting and licensing agencies.

  • Maintaining a database of provider's and client's information.
  • Verifying that providers are properly enrolled and credentialing is not expired.
  • Utilizing company's database and variety of software.
Candidate Info
10
years in
workforce
6
months
at this job
BA
Bachelor of Arts
Technology
42

HR Training and Credentialing Specialist

Member of the CPR Instructor team

  • Ensure all new hires complete certification requirements
  • Develops and maintains Human Resources data bases and filing systems
  • Reviews training records for completeness and accuracy
Candidate Info
12
years in
workforce
1
year
at this job
43

Credentialing Specialist and Graphic Designer

  • Credentialing specialist for a fast-paced, rapidly growing practice of 15 providers and 11 locations in Texas and California. Responsible for filing and maintaining the necessary paperwork, contracts and licenses in accordance with insurance company, hospital and state law guidelines.
  • Handle all of the enrollments, prior authorizations and daily maintenance of over 150 patients on the specialty medication Xolair. This requires an in-depth understanding of the dosing schedule requirements, clinical documentation and insurance payments, as well as constant communication with insurance companies, specialty pharmacies, drug manufacturers, and patients. A special focus on the needs of the patient, act as a bridge between the patient and the insurance company and quickly respond to all patient
  • Participate in the daily flow of office functions, including scheduling appointments, insurance verification, ordering, and training new administrative hires.
  • Create all promotional materials, business cards, pamphlets and other various artworks for office use, advertisements and media distribution for a growing company covering five different regions.
  • AdvancedMD and Healthfusion medical software.
Candidate Info
15
years in
workforce
6
years
at this job
BA
Advertising
Communication Design
44

Physician / Allied Health Credentialing Specialist

Generate and process applications for membership

  • Verified all information
  • Organized and maintain credentialing files for initial/reappointment of Medical and Allied Health professionals
  • Develop a timeline listing for each applicant
  • Serve as a liaison between Senior Management and Medical Staff
  • Monitor physician's expirables
  • Applied principles to determine physicians eligibility
  • Knowledge of JCAHO, NCQA standards
  • Prepared correspondences for external and internal requestors
  • Assist with special projects to include research
Candidate Info
8
years in
workforce
1
year
at this job
AAS
Associate of Applied Science
BS
Criminal Justice
45

Credentialing Specialist

The position comes with various responsibilities within the Revenue Cycle Management Department.

  • It is important to maintain medical staff within the organization by verifying their credentials.
  • It is part of the responsibility in my position to ensure that the hospital or health-care facility complies with federal and state regulations regarding licensure and certification of facilities and medical professionals.
  • A liaison between hospital and clinic administration and the medical staff, including physicians, technicians and nurses by maintaining the data for various providers within the Allina Health organization to track the expiration of certifications and licenses. I also ensure that health-care providers update their certification or licensing on time to be able to process new applications, renewals to provide physician privileges to the facilities and for reimbursement from various third party payers.
  • My position in affiliation and credentialing allows me to work independently, analyze data and conduct research while performing various demands of the job.
Candidate Info
13
years in
workforce
2
years
at this job
AAS
Business Management Program
AAS
Medical Secretary Program
46

Billing/credentialing Specialist

Billed Mental Health Claims With H-Codes and T-Codes( 75 claims daily)

  • Worked with regional centers ( ALTA, CVRC, SRC, ATAP, )
  • Worked with all major commercial insurances
  • Got authorizations for mental health
  • Helped families understand their co-pays
  • Answered phones/Customer Service
  • Worked aging reports monthly /billed reports daily
  • Medi-Cal/TAR'S
  • Credentialing for 5 offices and 10 BCBAs
  • Letters of Agreement
  • Billed Primary insurance/Secondary's
Candidate Info
6
years in
workforce
2
years
at this job
C
Medical Coding & Billing
47

Credentialing Specialist

  • Credential according to client's business model
  • Works closely with client, facility, group and provider in order to make the credentialing and privileging process run smoothly
  • Assists the facility or group with any outstanding items in order to complete the credentialing and privileging process
  • Responsible for making sure the client hasrequired documentation to meet their credentials standards based on their business model prior to the provider starting his/her assignment
  • Processes requests for initial applications, including data entry, application generation, and mailing and electronic delivery
  • Conducts continuous outreach to providers with outstanding initial and reappointment applications, second- and third-request letters, and telephone calls.
  • Processes initial and reappointment credentialing applications as assigned
  • Reviews and organizes incoming credentials applications, including data entry, organizing files in file order, and distributing selected documents, forms and checks to clients
  • Performs related and unrelated tasks as assigned
Candidate Info
14
years in
workforce
3
years
at this job
48

Credentialing Specialist

  • Processes all physician information including on boarding processes, licensure with state boards and privileging and reappointments for hospital affiliation; tracks progress of applications
  • Maintains client physician confidentiality while updating and tracking information in physicians' files; continuous maintenance of physician records; devoted customer service to both clients and physicians
  • Implementing and completing various projects to maintain organization and compliance
Candidate Info
13
years in
workforce
7
years
at this job
HS
Medical Billing & Coding Program

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