JACQUELINE WHITAKER
Homosassa,FL
Summary
Detail-oriented Credentialing Specialist skilled in application verification and data access management. Expertise in ensuring compliance and accuracy through primary source verification and access-level tier management. Proven ability to navigate complex certification and credential requests while fostering strong professional relationships.
Overview
18
18
years of professional experience
Work History
Billing/Credentialing Specialist
TMC Therapy at Home
Homosassa, Florida
03.2026 - Current
- Submit weekly therapy claims to Medicare, commercial, and secondary
payers
• Perform follow-up on unpaid/underpaid claims and resolve discrepancies
• Review denials, identify root causes, and submit appeals
• Post payments and adjustments in Net Health accurately
• Maintain AR aging reports and meet productivity benchmarks
• Handle patient billing inquiries and collections (copays, coinsurance,
deductibles)
• Identify trends affecting reimbursement and escalate as needed
Credentialing & Enrollment
• Manage Medicare Part B enrollment and updates via PECOS
• Submit and track credentialing applications for all payers
• Maintain CAQH profiles and provider records
• Monitor credentialing expirations and renewals
• Communicate with payers regarding application status
• Ensure compliance with regulatory and audit requirements
PROVIDER CREDENTIALING COORDINATOR
Mirra Healthcare
07.2025 - Current
- Process initial credentialing and recredentialing applications across multiple specialties (e.g., primary care, specialists, behavioral health, allied health, facility-based)
- Perform Primary Source Verification (PSV) tasks including, but not limited to:
- Performed verifications with AMA/AOA state medical boards to ensure licensing compliance for providers.
- Verified CAQH attestations to maintain compliance with credentialing standards.
- Confirmed state licensure and Medicare/Medicaid enrollments.
- Performed OIG and SAM exclusion checks to maintain compliance with regulatory standards.
- Utilized National Student Clearinghouse to confirm educational credentials of healthcare providers.
- Processed Freshworks ticket requests from providers to update demographic information in Credential Stream system, ensuring accuracy of provider directory and compliance of provider operations.
PATIENT CARE COORDINATOR
PT Solutions Physical Therapy
Spring Hill, FL
11.2022 - 07.2025
- Verify insurance, obtain referrals, prior authorizations and auth continuations using insurance websites and Availity.
- Processed patient payments and finalized plans of care to support patient financial responsibility and care continuity.
- Entered patient, insurance, and provider information into Epic and maintained accurate records.
- Ordered supplies, answered phones, and scheduled patient evaluations and follow-up appointments to ensure seamless patient flow.
CENTER DIRECTOR
Jenny Craig
Richmond, VA
11.2019 - 09.2022
- Managed business operations, achieving revenue and profitability targets while leading the assigned center.
- Assessed staffing needs, hired and trained staff, and managed performance to maintain operational efficiency.
- Coached clients through weight loss journeys, conducting daily outbound care and sales calls to enhance client retention.
- Drove center traffic, increased sales, and enhanced brand awareness in local market.
- Ordered supplies, stocked inventory, performed weekly inventory checks, and received weekly food shipments.
RECORDS COORDINATOR
Amedisys Home Health
Midlothian, VA
02.2019 - 08.2019
- Managed electronic and paper records for care center, ensuring organized and accessible documentation for staff and patients.
- Facilitated timely uploads of documents into EMR, improving data accessibility for clinical staff and enhancing patient care.
- Organized and scanned into the system four months of backlogged medical records, bringing all files to be current within a month.
- Prepared admission packets, processed orders and 485s, scheduled patients, and obtained authorization.
- Executed administrative tasks including receiving faxes, answering multi-line phones, performing data entry, ordering supplies, and managing billing processes.
- Resolved inquiries and requests from patients, clinicians, and physicians, enhancing communication and service delivery.
PROVIDER CREDENTIALING/DATA ANALYST
Aetna
01.2009 - 12.2018
- Entered and maintained contract data and provider fee schedules for in-network and out-of-network providers, ensuring accuracy for physicians, ancillary groups, and hospitals.
- Followed up with health plan credentialing and provider relations representatives on credentialing, re-credentialing, and demographic updates to ensure timely processing.
- Resolved issues raised by providers and internal/external customers through detailed research and analysis.
- Devised protocol to sort and filter information for loading hundreds of providers and payments into system, ensuring compliance with production and quality standards.
- Developed spreadsheet of providers with billing address, TIN, NPI, and specialty/department, streamlining selection of accurate provider records for claim payments and minimizing duplicate and non-par loads.
- Achieved company quality and production standards consistently throughout tenure.
- Supported multiple platforms to enhance project flexibility and efficiency.
OPERATIONS SPECIALIST
Aetna
01.2009 - 12.2013
- Updated provider information in CPD database and matched non-par provider details, enhancing accuracy of claims processing.
- Collaborated with PR reps to resolve provider address discrepancies through PITS tickets, Navigator issues, priority emails, and EFT TIN cleanups, improving data integrity.
- Exported changes from IDX to CPD, ensuring data consistency across systems.
- Executed special projects aligned with operational goals, supporting achievement of departmental objectives.
Education
PARALEGAL STUDIES -
Bryant & Stratton
Richmond, VA05-2000
GED -
Amelia County High School
Amelia Court House, VASkills
- Medicare and Medicaid management
- Tricare coordination
- Insurance verification processes
- Medical records administration
- Data entry accuracy
- Data analysis and reporting
- Scheduling and training
- Microsoft Office applications
- Word processing and Excel proficiency
- Office administration skills
- Customer service excellence
- Credentialing processes
Timeline
Billing/Credentialing Specialist
TMC Therapy at Home
03.2026 - Current
PROVIDER CREDENTIALING COORDINATOR
Mirra Healthcare
07.2025 - Current
PATIENT CARE COORDINATOR
PT Solutions Physical Therapy
11.2022 - 07.2025
CENTER DIRECTOR
Jenny Craig
11.2019 - 09.2022
RECORDS COORDINATOR
Amedisys Home Health
02.2019 - 08.2019
PROVIDER CREDENTIALING/DATA ANALYST
Aetna
01.2009 - 12.2018
OPERATIONS SPECIALIST
Aetna
01.2009 - 12.2013
PARALEGAL STUDIES -
Bryant & Stratton
GED -
Amelia County High School