Abidemi salako
Houston,USA
Summary
Detail-oriented Credentialing Specialist with over 6 years of experience in healthcare credentialing and regulatory compliance. Proficient in verifying and maintaining precise provider data, ensuring adherence to industry standards. Eager to contribute my expertise to enhance the achievements of a healthcare institution.
Overview
8
8
years of professional experience
Work History
Credentialing Specialist
Aetna Health
04.2023 - Current
- Streamlined credentialing workflows, reducing provider onboarding time and increasing application processing efficiency.
- Conducted comprehensive verification of provider credentials, licenses, education, work history, and malpractice coverage to ensure full compliance with NCQA, CMS, and state regulations.
- Collaborated with providers, payers, and internal departments to resolve discrepancies and ensure timely completion of credentialing files.
- Maintained accurate and up-to-date provider records in credentialing software (e.g., CAQH, MD-Staff, or similar platforms).
- Audited credentialing files regularly to ensure completeness and readiness for internal and external compliance reviews.
- Initiated and tracked re-credentialing processes to ensure continued eligibility and prevent lapses in provider participation.
- Generated reports for leadership on application status, turnaround times, and compliance metrics to support data-driven decision-making.
- Trained and mentored junior staff on credentialing workflows, documentation standards, and regulatory compliance.
- Partnered with IT and quality teams to enhance credentialing system functionality and implement automation where applicable.
- Ensured confidentiality and secure handling of sensitive provider information in accordance with HIPAA and company policy.
Credentialing Specialist
Kelsey- Seybold Clinic
05.2019 - 04.2023
- Managed the credentialing process for a diverse range of healthcare providers.
- Expertise in collecting, validating, and maintaining precise provider data, including licenses, certifications, and insurance.
- Conducted thorough primary source verification, ensuring strict regulatory compliance.
- Facilitated cross-functional communication to streamline the credentialing process.
- Maintained impeccable provider credentialing records, adhering to industry standards and compliance requirements.
- Prepared and submitted applications for provider enrollment and recredentialing with insurance payers.
- Actively engaged with healthcare providers, resolving credentialing-related inquiries and fostering positive relationships.
- Monitored credentialing expirations and ensured timely renewals.
- Prepared for and participated in regulatory audits by government agencies and third-party organizations.
- Implemented and enforced policies and procedures to enhance efficiency, accuracy, and compliance in credentialing.
Customer Support Specialist
Serenity Healthcare
04.2017 - 04.2019
- Assisted customers in using company products and services, ensuring a positive experience.
- Managed customer accounts, processed orders, and addressed billing inquiries.
- Troubleshot technical issues and provided guidance for issue resolution.
- Conducted customer satisfaction surveys to gather feedback.
- Contributed to the development of training materials for new hires.
- Collaborated with the product development team to communicate customer feedback.
Education
Bachelor of Science - Business Administration And Management
Lagos State University
Lagos, Nigeria12-2013
MBA - Project Management
Indiana Institute of Technology
Fort Wayne, IN07-2024
Skills
- ServiceNow
- SAP
- PSV Web Sites
- CAQH
- Microsoft Suites (Excel, Word, PowerPoint & Outlook)
- Microsoft Teams
- Healthcare credentialing and privileging
- Primary source verification
- Provider enrollment and recredentialing
- Regulatory compliance (HIPAA, CMS, NCQA)
- Data management and recordkeeping
- Attention to detail
- Communication
- Team collaboration
- Problem-solving and conflict resolution
- Time management and organization
- Symplir
- Smart Cred
Timeline
Credentialing Specialist
Aetna Health
04.2023 - Current
Credentialing Specialist
Kelsey- Seybold Clinic
05.2019 - 04.2023
Customer Support Specialist
Serenity Healthcare
04.2017 - 04.2019
Bachelor of Science - Business Administration And Management
Lagos State University
MBA - Project Management
Indiana Institute of Technology
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