MATTHEW SMITH
ROSWELL
Summary
Seasoned Credentialing Specialist with a background in biology, healthcare credentialing, and customer service. Skilled in provider/healthcare credentialing, provider verification and healthcare compliance. Credentialing Specialist with four years of experience in healthcare credentialing and compliance, adept at verifying provider credentials and ensuring regulatory adherence. Proficient in Adobe Acrobat, Excel, CRM systems, VMS systems and other key software, with a strong focus on accuracy and efficiency. Committed to advancing industry standards through innovative solutions and exceptional communication skills.
Overview
4
4
years of professional experience
Work History
Credentialing Specialist (Remote)
Soliant Healthcare
Peachtree Corners
03.2022 - Current
- Hospital and healthcare credentialing using JCAHO regulations and standards
- Daily communications with nursing and allied healthcare physicians to obtain needed regulatory and client requirements.
- Manage healthcare vendor management systems (VMS) and CRM systems
- Assist with investigating a variety of employee-related issues, incidents, and complaints
- Experience with health care accreditation and regulatory standards including NCQA requirements
- Conduct background screenings, drug screenings and handle sensitive, complex, and confidential information
- Verify professional healthcare licenses, certifications, primary source verifications and ensure client-specific compliance
- License verifications using NPDB, state boards and NURSYS databases. NSOPW, OIG, OFAC and SAM searches for all candidates.
- Initiate, monitor and complete onboarding process for healthcare candidates
- Maintain and frequently update our credentialing database and tracking systems such as Bullhorn and HCP Tracker
Credentialing Specialist (Remote/Contract)
Delta Dental
Atlanta
07.2024 - 02.2025
- Verify and audit Dental provider credentials such as DEA's, COI's, CAQH's and Dental Licenses
- Ensure the eligibility of physician medical malpractice, professional liability, or tort.
- Communicate with Providers via email and phone to obtain missing credentials needed for processing
- Identify NPI and TIN values to properly assign dental providers to select organizations
- Process and log dental provider credentials using CRM and VMS systems
- Enter credential information into a credentials tracking system
- Run License Verifications and searches such as NSOPW, OIG, OFAC, SAM and primary source verifications
- Usage of 3rd party vendors to run background screenings including Education and Employment verifications and Motor vehicle Reports
- Physician credentialing using CAQH and NCQA regulatory standards
- Audit Dental Provider credentials to ensure compliance and maintain expired credentials for renewal
- Quick and efficient communication with providers and team members to effectively meet all company and client standards
- Ensure all provider information is precise and accurate in a timely manner to meet credential deadlines
Healthcare and Military Customer Service Representative (Remote)
Health Net Federal Services (Pearl Interactive)
Atlanta
03.2023 - 10.2023
- Communicate with hospital providers to confirm deductibles, co-pays, policy details, eligibility, and benefits
- Assist with investigating a variety of patient-related issues, policy statuses, eligibility, and complaints
- Verify patient demographics and ensure patient-specific compliance via HIPAA regulations
- Assists patients and providers with personal confidential information
Technical Manager/COVID Tester (Hybrid)
AILM Medical/Inspire Diagnostics
Atlanta
09.2021 - 03.2023
- Marketed AILM services to businesses in person, by phone and via email
- Provide exceptional customer service when communicating with patients and providers
- Streamlined patient data verification processes, ensuring HIPAA compliance and improving accuracy in eligibility and benefit confirmations
- Resolved complex patient-related issues and complaints, providing empathetic support while maintaining confidentiality and policy adherence
- Optimized communication with hospital providers, reducing inquiry response times and enhancing overall service efficiency
- Researched marketing channels including social media and developed marketing strategies to increase the number of engagements for AILM to provide on-site testing at many companies
- Analyzed performance and made strategy adjustments, as needed
- Stayed current on marketing trends
- Contacted potential clients in-person and via written correspondence (emails, social media)
- Managed technical systems for small company, along with EMR/portal systems and company CRM
- Created forms using Adobe Acrobat
- Audited medical inventory and re-staffed supplies
- Administered COVID 19 tests, including rapid antigen testing, rapid PCR (RT-PCR), and PCR testing
- Administered viral swabbing for COVID 19
- Trained new employees in best practices
- Traveled 50% to various cities and states to perform COVID viral testing and set up event space, as needed
Certified Technician
Cook's Pest Control
Rex
10.2020 - 07.2021
- Company Overview: Entomology
- Analyzed and identified insects and wildlife
- Diagnosed and prevented any further damage
- Prescribed and administered appropriate chemical treatment(s) to eradicate insects and rodents or redirect wildlife
- Identified numerous insects, pests, and rodents using evidence such as droppings
- Stayed up to date on the latest industry developments, trends, and regulations
- Entomology
- Advanced company brand by providing professional and friendly customer service
- Received 5-star (out of 5) ratings from customers on a consistent basis
- Made pre-visit calls to customers to confirm date of service and schedule a convenient time
- Advised customers of services performed and if there are problems to be addressed
- Assisted with sales by offering upgrades or other needful services to existing customers
- Reached out to family, friends, and neighbors about services to drive sales
- Accounts receivable - Made calls to collect delinquent accounts
Guest Relations / Customer Service (College)
Hampton Inn
Locust Grove
- Assisted with hotel sales and marketing
- Provided exceptional customer service and assistance to guests
- Received constant 5-star ratings (out of 5)
Biology Department (College)
Georgia Power
Atlanta
- Observed environmental hazards that affect animals, focusing mainly on hazards near the innercity
- Participated in research to provide solutions
Education
Bachelor of Science - BIOLOGY
Clayton State University
Morrow, GA05.2020
MAJOR - BIOLOGY
Savannah State University
Savannah, GA01.2017
Skills
- JCAHO compliance sandards
- NCQA credentialing standards
- CAQH credentialing standards
- Microsoft Office (Outlook, Word, Excel, Powerpoint)
- Adobe Acrobat
- Regulatory Compliance
- Healthcare Compliance
- Background checks
- Detail-oriented
- Employee onboarding
- HIPAA compliance
- CRM and VMS management
- Solo practitioner credentialing
- Insurance procedures
- Regulatory compliance
- Conflict Resolution
- Credentialing Software
- Process Improvement
- Documentation Skills
- Credential Tracking
- Audit Processes
- Data Entry
- Onboarding Processes
- Primary Source Verifications
- Dental Compliance
- Compliance Standards
- License verifications
- Provider enrollment
- Leadership
- Communication Skills
- Problem-Solving
- Data Analysis
- Time Management
- Customer Service
Additional Information - Research Experience
- 12+ months Biological Science Research Experience
- Conducted research experiment analyzing the effects of how organic antibacterial mechanisms prevent and inhibit Community Associated Methicillin Resistant Staphylococcus aureus (CA-MRSA)
Timeline
Credentialing Specialist (Remote/Contract)
Delta Dental
07.2024 - 02.2025
Healthcare and Military Customer Service Representative (Remote)
Health Net Federal Services (Pearl Interactive)
03.2023 - 10.2023
Credentialing Specialist (Remote)
Soliant Healthcare
03.2022 - Current
Technical Manager/COVID Tester (Hybrid)
AILM Medical/Inspire Diagnostics
09.2021 - 03.2023
Certified Technician
Cook's Pest Control
10.2020 - 07.2021
Guest Relations / Customer Service (College)
Hampton Inn
Biology Department (College)
Georgia Power
Bachelor of Science - BIOLOGY
Clayton State University
MAJOR - BIOLOGY
Savannah State University
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