Summary
Overview
Work History
Skills
Timeline
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Carol Clancy

Massapequa,NY

Summary

Dynamic Credentialing Specialist with extensive experience and commitment to excellence in healthcare operations. Proven expertise in leveraging skills in research, Microsoft EXcel and CAQH to enhance credentialing processes. Adept at quickly adapting to new environments and technologies, ensuring efficient workflows and compliance. Strong dedication to maintaining high standards of accuracy and detail in all tasks.

Ready to contribute to a collaborative team focused on delivering quality service in the healthcare sector. Proficient in EDI, ERA and EFT enrollment for many different payers that use a clearinghouse for claims. Familiar with payers in different states.

Overview

21
21
years of professional experience

Work History

Credentialing Specialist

OptumHealth
, NY
04.2023 - 02.2025
  • Primary focus is on verifying and validating the qualifications of healthcare providers. This role involves meticulous attention to detail to ensure compliance with industry standards and regulations. Engaging in thorough research and analysis of provider credentials is essential to maintain the integrity of the credentialing process. Collaborating with various teams ensures that all documentation is accurate and complete, facilitating smooth communication within the organization.
  • Streamline the credentialing process, reducing turnaround time for provider approvals.
  • Proficient in ERA, EDI, and EFT provider enrollments that use a clearinghouse.
  • Proficient in many different players that reside outside of New York. Maintain comprehensive records, improving access to providers' information for internal teams.
  • Communicate effectively with providers to resolve discrepancies and gather necessary documents.
  • Proficient in using the CAQH application and keeping the web application updated for providers.

Credentialing Specialist

Change Healthcare
01.2016 - 04.2023
  • Coordinated with healthcare professionals to collect necessary documentation for credentialing.
  • Researched discrepancies between submitted provider data and verified sources when necessary.
  • Monitored expiration of licenses and certifications, notifying providers of renewal requirements.
  • Reviewed and processed credentialing applications to ensure accuracy, completeness, and compliance with all accreditation standards.
  • Maintained informational resources, tracking and documenting requests for updates, certification and credentialing.
  • Processed re-credentialing applications for existing providers according to contractual requirements.
  • Completed enrollments into Medicaid, Medicare and private insurance plans.
  • Worked with cross-functional teams to achieve goals.

Credentialing Specialist

McKesson
01.2004 - 01.2016
  • Proficient in provider applications for many providers/hospitals. Linked providers to the group with Medicare and Medicaid.
  • Proficient with the NPPES registry to verify providers/hospitals' NPI numbers.
  • Proficient in Medicare, Medicaid, and Medicaid Revalidation applications.
  • Familiar with a lot of out-of-state payers for EDI, ERA, and EFT enrollment.
  • Addressed and resolved discrepancies in provider documentation during credentialing.
  • Ensured timely completion of credentialing processes by providing guidance to providers on required documentation.
  • Prepared correspondence for various departments concerning credentialing updates or requests for additional information.
  • Checked applications for missing information and organized all paperwork.
  • Ensured strict confidentiality of provider information in accordance with HIPAA regulations.
  • Validated primary source documents such as licenses, diplomas, certifications and other related credentials.
  • Interacted regularly with representatives from health plans and commercial payers regarding credentialing matters.
  • Coordinated with healthcare professionals to collect necessary documentation for credentialing.
  • Monitored expiration of licenses and certifications, notifying providers of renewal requirements.
  • Reviewed and processed credentialing applications to ensure accuracy, completeness, and compliance with all accreditation standards.
  • Worked effectively in team environments to make the workplace more productive.
  • Provided support and guidance to colleagues to maintain a collaborative work environment.
  • Demonstrated strong problem-solving skills, resolving issues efficiently and effectively.

Skills

  • Application coordination
  • Proofreading
  • Facility support
  • Application management
  • Provider enrollment
  • Solo practitioner credentialing
  • Management collaboration
  • Document review
  • Microsoft Office
  • Connect Center clearinghouse

Timeline

Credentialing Specialist

OptumHealth
04.2023 - 02.2025

Credentialing Specialist

Change Healthcare
01.2016 - 04.2023

Credentialing Specialist

McKesson
01.2004 - 01.2016

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Carol Clancy