Ashley Jackson
Buford,Georgia
Summary
Seven-year Credentialing Verification Specialist in healthcare sector adept at streamlining credentialing and enrollment processes with strong focus on data accuracy and verification.
Overview
6
6
years of professional experience
Work History
Medical Staff Credentialing Coordinator
Delta Dental Insurance Company
Alpharetta, GA
03.2020 - Current
- Establish timelines for credentialing activities, ensuring accuracy and efficiency
- Monitor and validate credentialing data, maintaining confidentiality
- Implement physician enrollment processes, coordinating with Medicare and Medicaid
- Maintain provider information, responding to inquiries promptly
- Partner with cross-functional teams to streamline physician enrollment, enhancing communication and reducing delays in provider onboarding
- Organized and maintained all applications, verifications, and other documents related to provider credentials.
- Facilitated the appointment process by providing information on privileges requested.
- Tracked licensure expiration dates and coordinated renewal activities with providers.
- Assisted in preparing reports for departmental meetings regarding provider status changes.
- Answered inquiries from providers regarding application status or required documentation.
- Prepared monthly reports summarizing provider data such as license expirations or renewals.
- Followed up with applicants to ensure timely completion of their credentialing file packages.
- Maintained informational resources, tracking and documenting requests for updates, certification and credentialing.
- Performed primary source verifications such as criminal histories, licenses and board certifications.
- Checked applications for missing information and organized all paperwork.
- Coordinated with healthcare professionals to collect necessary documentation for credentialing.
- Facilitated communication between departments to resolve credentialing issues efficiently.
- Conducted primary source verification of licensure, education, training, malpractice history.
Onboarding Provider Administrative Specialist-SME
Delta Dental Insurance Company
07.2018 - 03.2020
- Implements the physician enrollment process for physicians and mid-levels with Medicare and Medicaid
- Maintain the timelines on enrollment schedules, communicate with providers and other departments to update as needed, clarify carrier information requirements, and maintain a strict level of confidentiality for all matters pertaining to provider credentials
- Reviews new client packet information to determine any enrollment issues
- Coordinates credentialing data needed for enrollment, contracting, and other related purposes
- Works closely with Physicians to obtain missing documentation for providers pertaining to provider enrollment
- Obtains required client signatures and follows up with the carriers on documentation submitted
- Maintains provider information and demographics for all providers
- Responds to internal and external inquiries on routine enrollment and contract matters timely
- Monitors and advises clients on enrollment re-validations
- Repeat Step-Up and Award recognized employee for both production and quality
- Create/Updates DLP for Provider Onboarding Department
- Completes internal QA spot check on cases processed by team to ensure accuracy
- Assist with special projects.
- Coordinate with IT to develop automated tools for credentialing, increasing data validation
Education
Health Care Science -
Atlanta Technical College
Atlanta, GASkills
- Self-motivated
- Team player
- Prioritization
- Time management
- Communication
- Organization
- Verbal skills
- Written skills
- Quick learner
- Microsoft Office
- Detail-oriented
- Typing
- Macess
- Compliance Monitoring
- Database Maintenance
- Policy Enforcement
- Meeting facilitation
- Data Management
- Credential verification
- Data Acquisition
- License verifications
- Epic
References
References available upon request.
Timeline
Medical Staff Credentialing Coordinator
Delta Dental Insurance Company
03.2020 - Current
Onboarding Provider Administrative Specialist-SME
Delta Dental Insurance Company
07.2018 - 03.2020
Health Care Science -
Atlanta Technical College
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