With over a decade at Blue Cross Blue Shield of Alabama, I've excelled in credentialing oversight and team collaboration, enhancing provider network integrity and compliance. My proactive approach in managing re-credentialing applications and spearheading credentialing committee reports has significantly contributed to operational excellence, showcasing my adeptness in healthcare regulations and interpersonal skills.
Accumulated five years of experience in customer service before moving to claims.
Transferred to Credentialing Department in 2011, managing re-credentialing applications for existing network medical providers.
I was asked to handle working our monthly credentialing committee report. Provider files were submitted monthly to a designated committee to decide on Network entry. I was tasked with flagging each provider in our database for network status. I was also responsible for for checking provider status in the PECOS system, pulling Medicare Sanctioned provers monthly, placing garnishments and levies on providers from our legal dept., and working ad hoc projects and tasks as needed.