Amy Mooney
CHG Healthcare
Webster,US
2
Languages
1
Certification
10
years of professional experience
Credentialing & Provider Enrollment Specialist with over 10 years of expertise in healthcare settings, specializing in provider onboarding, payer enrollment, and credentialing. Demonstrates a strong ability to streamline operations, reducing accounts receivable wait times and minimizing claim denials. Holds PESC certification, with a focus on enhancing efficiency and compliance within medical billing and insurance verification processes.
Work History
Delegated Credentialing & Payor Enrollment Specialist
1 Year 7 Months- Initiate and support the practitioner application process (for multiple states) by sending, receiving, and analyzing practitioner documents and data import to determine completeness in preparation for payor enrollment and credentials verification process.
- Responsible for accurate data entry to ensure the integrity of credentialing information in applicable database(s)
- Enroll providers with client payors to include Medicare, Medicaid and state and federal commercial health plans and follow up as required until process complete.
- Update CAQH and NPI information consistent with client practice information.
- Responsible for gathering, verifying, evaluating highly confidential and sensitive health care practitioner credentials consistent with departmental guidelines and accreditation standards.
- Respond to all practitioners, client health plan and internal inquiries in a timely manner.
- Monitor expiring licensure, board, and professional certifications and other expirable documents with practitioners within the prescribed timeframe.
- Maintain practitioner paper and electronic data files for clients; utilizing CAQH to submit practitioner data as required to credential individual practitioners.
- Collaborate with participating clients in a professional manner, department manager, and/or external agencies to facilitate and ensure smooth hand-off during the credentialing process.
- Follow up with individual practitioners and internal and external entities to resolve discrepancies identified during the credentialing process.
- Perform all aspects of credentialing verification, including initial credentialing and recredentialing to ensure current credentials and timely handoff and/or review and approval of practitioner files.
- Consulting and training staff of clients on payer enrollment
Sr. Credentialing & Enrollment Specialist
10 Months- Processed [number] provider enrollments per week while keeping payer records current and organized.
- Led credentialing and enrollment processes in alignment with regulatory standards and HIPAA Compliance requirements.
- Streamlined provider onboarding workflows to speed up remote intake and reduce administrative delays.
- Managed provider enrollment with government and commercial payers while coordinating credentialing documentation.
- Handled delegated and facility credentialing, recredentialing, and primary source verification for provider records.
- Supported assigned projects by resolving enrollment issues and maintaining responsive customer service throughout the process.
Credentialing & Enrollment Specialist
6 Months- Completed assigned onboarding and enrollment projects aligned to provider setup priorities.
- Managed multiple credentialing cases weekly across multiple markets while maintaining compliance and timely completion.
- Coordinated provider onboarding, payer enrollment, and credentialing tasks across Ohio, Texas, Florida, Washington, and California markets.
- Verified supporting documentation and primary source records to move cases forward with accuracy and compliance.
- Tracked assigned projects, resolved case issues, and kept completion status current for stakeholder review.
Credentialing Specialist
1 Year 4 Months- Credentialed physicians for oncology practices across New Jersey and Pennsylvania, keeping provider files current and submission-ready.
- Handled hospital credentialing for group and individual providers, coordinating payer enrollment and follow-up through completion.
- Completed provider onboarding steps by collecting documentation, tracking requirements, and coordinating next actions with internal teams.
- Verified provider information through primary source review and insurance verification before submitting enrollment materials.
- Supported special projects as assigned, including payor enrollment consulting and other credentialing tasks.
Credentialing Specialist & Enrollment Specialist
8 Months- Credentialing of Maryland, California and Florida practices and providers, training of staff, special projects as assigned. Credentialing of V-Rad provider, reviewing of locum and MQSA provider packets.
Property Tax Research Associate
8 Months- Research of tax data and process tax payments. Processes and researches a high volume of issues, where issues are typically more complex that require moderate knowledge of customer and company requirements. Makes outbound phone calls to taxing authorities to procure data. May perform a variety of clerical functions within Tax Services to ensure timely procurement and accurate payment of taxes.
- Conducts research of tax data.
Provider Enrollment Specialist
3 Years 5 Months- Enrollment of Providers to Medicaid/Excellus/MVP, Medicaid revalidations for individual providers and groups. Recertification of Medicaid E Tins and management of the Claims Logic report. Enrollment of Behavioral Health and Dental providers for all payers. Researching enrollment issues and solving enrollment problems for Medicaid and Excellus. Assisting in training new employees to the team, and assisting the team lead, manager, and director with additional assignments as needed
Education
Associates Degree - Business Management
Skills
Provider Onboarding
Payer Enrollment
Provider Credentialing
Medical Billing
Insurance Verification
Financial Counseling
HIPAA Compliance
Customer Service
Accounts Receivable
Accounts Payable
payor enrollment consulting
provider primary source verificaiton
Certification
PESC Certification
LANGUAGES
English
Native
Interests
Honor Flight Rochester Volunteer 2016-Present
Solo Guardian/Mission Crew-Advanced
Mission Assistant
Safety Assistant/Fundraising/Event Planning /Veteran &Guardian Caller/HFR Doll Leader
Personal Information
Title: Senior Credentialing& Provider Enrollment Specialist
ADDITIONAL INFORMATION
- Software Proficiency
- MDStaff
- Modio
- PECOS
- AVAILITY
- ONBOARD PRO
- NAVINET
- MULTIPLE MEDICAID PORTALS
- EXCEL
- SMART SHEET
- TEAMS
- WORD
- POWER POINT
- ADOBE
- CAQH
- APOGEE
- CARE CONNECT
- Claims Logic (TriZetto)
- EPIC
- EGYNTE
- NPDB
- NPPES
- DOCUSIGN
Timeline
Delegated Credentialing & Payor Enrollment Specialist
CHG Healthcare
02.2025 - CurrentRead More
Sr. Credentialing & Enrollment Specialist
Payradvisors
01.2024 - 11.2024Read More
Credentialing & Enrollment Specialist
Sound Physicians
04.2023 - 10.2023Read More
Credentialing Specialist
OneOncology
12.2021 - 04.2023Read More
Credentialing Specialist & Enrollment Specialist
RadNet
03.2021 - 11.2021Read More
Property Tax Research Associate
CoreLogic
07.2020 - 03.2021Read More
Provider Enrollment Specialist
Rochester Regional Health System
12.2016 - 05.2020Read More
Bryant & Stratton Business School
Associates Degree from Business Management
Read More