Kayona Henning
Milwaukee
Summary
Knowledgeable credentialing specialist brings knack for performing successful application checks and verifying informational resources. Several years of experience overseeing data access and security based on up-to-date trends and standards. Adept at verifying primary sources and access-level tiers. Proven communicator and relationship builder expertly tracks complex update, certification and credential requests.
Overview
16
16
years of professional experience
Work History
Credentialing Specialist II
Managed Health Services
Milwaukee
02.2018 - Current
- Informed job applicants of duties and responsibilities, compensation, and benefits.
- Confirmed facility and user credentials to initiate and maintain registration and enrollment processes.
- Assisted in the accreditation process by gathering and submitting required documentation.
- Conducted regular audits of credentialing files to ensure accuracy and completeness.
- Performed initial review for new providers to determine eligibility for enrollment into the network.
- Coordinated with healthcare professionals to collect necessary documentation for credentialing.
- Conducted thorough background checks and verified educational and professional qualifications.
- Addressed and resolved discrepancies in provider documentation during credentialing.
- 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.
- Coordinated with internal departments such as medical staff services or risk management to resolve any issues identified during the verification process.
- Maintained detailed records of provider data in the credentialing database system.
- Maintained up-to-date records of credentialing statuses in database systems.
Provider Data Management
Managed Health Services
11.2010 - 02.2018
- Accurately entered and maintained provider and practitioner profiles within the Portico system, ensuring data integrity and compliance with health plan requirements
- Conducted thorough audits of new applications, contributing to the quality assurance of the credentialing process
- Managed the credentialing database, effectively updating records and securing necessary documentation from healthcare providers to maintain up-to-date information
Customer Service Representative
Managed Health Services
04.2009 - 11.2010
- Addressed and resolved billing inquiries, ensuring clear communication and customer satisfaction
- Coordinated and scheduled appointments, effectively liaising between members and providers
- Provided accurate information on benefits and maintained compliance with HIPAA regulations
Education
BBA - Business Administration
Springfield College
Springfield, MA05-2018
Skills
- Microsoft Word
- Microsoft Excel
- Microsoft PowerPoint
- Oral Communication
- Written Communication
- Time Management
- Research Skills
- Understanding of Laws
- Understanding of Regulations
- Understanding of Procedures
- Credentialing process
- Data verification
- Provider verification
- Credentialing processes
- Data management
- Compliance regulations
- Record auditing
- Database maintenance
- Customer service
- Attention to detail
- Problem solving
- Organizational skills
- Quality assurance
- License verifications
- Provider enrollment
- [Software] expertise
- Proofreading
- Document review
- Application coordination
- Data acquisition
- Regulatory compliance
- Credential verification
- Report generation
- Community health center credentialing
- HIPAA compliance
- Solo practitioner credentialing
- Insurance procedures
- Application management
- Background checks
- Accreditation information management
- Provider relations
- Facility credentialing
- Complex Problem-solving
- Self motivation
- Task prioritization
- Decision-making
- Time management abilities
- Onboarding process
Timeline
Credentialing Specialist II
Managed Health Services
02.2018 - Current
Provider Data Management
Managed Health Services
11.2010 - 02.2018
Customer Service Representative
Managed Health Services
04.2009 - 11.2010
BBA - Business Administration
Springfield College