Carol Mister
Nottingham,MD
Summary
Detail-oriented Credentialing Specialist with 27 years of experience in compliance verification, document accuracy, and background checking. Proven ability to maintain accurate records and ensure timely completion of credentialing processes.
Overview
27
27
years of professional experience
Work History
Credentialing Specialist II
Magellan Health (Remote)
Columbia, MD
07.1999 - Current
- Managed the credentialing process for healthcare professionals within the organization.
- Verified provider credentials to ensure compliance with regulatory standards.
- Reviewed applications and documentation for accuracy and completeness.
- Communicated with providers regarding credentialing status and requirements.
- Maintained accurate records in credentialing databases and systems.
- Ensured timely completion of credentialing processes by providing guidance to providers on required documentation.
- Reviewed and processed credentialing applications to ensure accuracy, completeness, and compliance with all accreditation standards.
- Performed primary source verifications such as criminal histories, licenses and board certifications.
- Processed re-credentialing applications for existing providers according to contractual requirements.
- Conducted background checks on potential providers utilizing various resources including state licensing boards, OIG and GSA Exclusion List, NPDB.
- Investigated inconsistencies in submitted provider data against verified sources.
- Conducted thorough background checks and verified educational and professional qualifications.
- Ensured strict confidentiality of provider information in accordance with HIPAA regulations.
Education
Some College (No Degree) - Computer And Information Sciences
Morgan State University
Baltimore, MarylandSome College (No Degree) - Business Management
University of Phoenix
Columbia, MDSkills
- Credentialing management and compliance verification
- Document accuracy and data maintenance
- Background checking and provider communication
- Attention to detail
- Remote work proficiency
- Microsoft Office Suite expertise
Accomplishments
- Network Star Program Certificate 2016
Timeline
Credentialing Specialist II
Magellan Health (Remote)
07.1999 - Current
Some College (No Degree) - Computer And Information Sciences
Morgan State University
Some College (No Degree) - Business Management
University of Phoenix