Audrey Carver

• Managed over 300 provider files monthly
• Expedited the onboarding process for new providers, ensuring timely completion of all required documentation and verifications.
• Received and evaluated applications to look for missing and inaccurate information.
• Ensured compliance with industry standards by regularly updating policies and procedures related to credentialing.
• Managed multiple priorities effectively, resulting in the on-time completion of credentialing tasks for numerous providers simultaneously.
• Conducted primary source verifications such as background checks and board certifications.

• Managed credentialing files with strict adherence to confidentiality and privacy laws, ensuring secure handling of sensitive information.
• Addressed and resolved discrepancies in provider documentation, maintaining high level of data integrity.
• Pre-screened resumes prior to sending to corporate hiring managers for consideration.
• Expedited the onboarding process for new providers, ensuring timely completion of all required documentation and verifications.
• Enrolled providers and Medicaid, Medicare, and private insurance plans.
• Obtained NPI numbers for providers and facilities and updated existing profiles.

• Served as a resource for departmental staff by maintaining a thorough understanding of current trends and best practices in the credentialing field.
• Assisted in maintaining accreditation status by preparing necessary reports and materials for site visits and audits.
• Tracked expiration dates on documents and communicated with appropriate staff to avoid late filing.
• Coordinated continuing education opportunities for medical staff, promoting professional growth and development among affiliated providers.
• Contributed to risk management initiatives by monitoring expiring licenses, certifications, and insurances, notifying providers of renewal requirements in a timely manner.
• Minimized potential legal complications by ensuring adherence to federal and state regulations governing healthcare practitioners'' licensure and certification requirements.
• Enrolled providers and Medicaid, Medicare, and private insurance plans.
• Assisted with managed care auditing processes and performed internal file audits.
• Obtained NPI numbers for providers and facilities and updated existing profiles.

Examples of Work:

• Verify credentials,
• Process Provider on Boarding Applications
• Obtain medical licenses when necessary
• Third party, Medicare, and Medicaid Enrollment
• Assist with payor contracting
• NCQA Compliance, CAQH enrollment, PECOS,
• ALL Primary Source Verification