Myra Smith
Florence,SC
Summary
Provider Credentialing Specialist with 1+ year of direct health plan credentialing experience and over four years of remote healthcare operations experience. Highly organized professional known for managing high-volume credentialing workloads, meeting strict deadlines, and maintaining accurate provider records. Demonstrated ability to work independently and collaboratively while ensuring compliance with NCQA, CMS, state regulations, and HIPAA. Strong attention to detail, problem-solving ability, and excellent written, verbal, and interpersonal communication skills.
Overview
6
6
years of professional experience
Work History
Provider Credentialing Consultant
Centene
Remote
02.2023 - Current
- Perform provider credentialing and re-credentialing activities for a health plan, ensuring compliance with NCQA, CMS, and state credentialing standards
- Review, verify, and validate provider applications, licenses, certifications, and supporting documentation for completeness and accuracy.
- Maintain and update provider records within credentialing systems to ensure data integrity and audit readiness.
- Identify, investigate, and resolve discrepancies using strong analytical and problem-solving skills.
- Communicate with providers, internal departments, and stakeholders to obtain missing information and resolve credentialing issues.
- Manage high-volume credentialing workloads while consistently meeting productivity and turnaround time requirements.
- Demonstrate strong organizational and time-management skills in a fast-paced remote environment.
- Work independently with minimal supervision while collaborating effectively within a team setting.
- Ensure strict adherence to HIPAA regulations and organizational confidentiality policies.
Credentialing Claims Specialist
UnitedHealth Group
Remote
04.2021 - 02.2023
- Reviewed and processed medical claims while verifying provider, patient, and claim data for accuracy and compliance.
- Supported credentialing-adjacent functions by validating provider information against internal and regulatory standards.
- Analyzed documentation and data elements to ensure adherence to healthcare policies and quality requirements.
- Identified errors and discrepancies, collaborating with internal teams to resolve issues efficiently.
- Managed high-volume workloads under strict turnaround times using strong prioritization and organizational skills.
- Maintained detailed electronic documentation to support audits, appeals, and quality reviews.
- Applied strong written and verbal communication skills in interactions with internal stakeholders.
Patient Services Representative
Randstad
Remote
01.2020 - 04.2021
- Supported credentialing and verification workflows by confirming insurance coverage, eligibility, and patient demographics.
- Handled high volumes of inbound healthcare and insurance-related inquiries with professionalism and accuracy.
- Collected, reviewed, and documented patient and insurance information within CRM and healthcare systems.
- Escalated documentation gaps and discrepancies for timely resolution.
- Maintained strict confidentiality and compliance with HIPAA regulations.
- Demonstrated strong interpersonal communication skills while working in a fast-paced remote environment.
Education
High School Diploma - undefined
South Florence High School
Florence, SCSkills
Provider Credentialing & Re-Credentialing
Health Plan Credentialing Operations
NCQA, CMS & State Credentialing Standards
Credentialing Documentation Review
Provider Data Verification & Maintenance
High-Volume Workflow Management
Deadline & Time Management
Quality Assurance & Compliance Monitoring
Problem Resolution & Discrepancy Analysis
Independent & Team-Based Collaboration
HIPAA & Confidentiality Compliance
Written, Verbal & Interpersonal Communication
Timeline
Provider Credentialing Consultant
Centene
02.2023 - Current
Credentialing Claims Specialist
UnitedHealth Group
04.2021 - 02.2023
Patient Services Representative
Randstad
01.2020 - 04.2021
High School Diploma - undefined
South Florence High School