Nicole Roskin
Spring,TX
Summary
Proven Credentialing Specialist with a track record of enhancing provider satisfaction and streamlining credentialing processes at AmeriHealth Caritas. Skilled in HIPAA compliance and organizational development, I significantly improved application turnaround times. My expertise in database maintenance and fostering team collaboration has led to more efficient operations and a reduction in errors by over 30%.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Credentialing Specialist
AmeriHealth Caritas
06.2023 - Current
- Collaborated with healthcare providers to gather necessary information for accurate credentialing decisions.
- Managed multiple priorities effectively, resulting in the on-time completion of credentialing tasks for numerous providers simultaneously.
- Conducted audits of provider files, ensuring all necessary documents were up-to-date and compliant with regulatory requirements.
- Enrolled providers and Medicaid, Medicare, and private insurance plans.
- Conducted primary source verifications such as background checks and board certifications.
- Safeguarded confidential provider information by adhering to strict data privacy regulations and company policies.
- Facilitated communication between departments, resulting in improved collaboration during the credentialing process.
- Received and evaluated applications to look for missing and inaccurate information.
- Obtained NPI numbers for providers and facilities and updated existing profiles.
- Demonstrated excellent problem-solving skills when confronted with complex issues or discrepancies during the credentialing process.
- Enhanced credentialing processes by streamlining documentation and verification procedures.
- Developed strong relationships with external organizations, leading to increased cooperation during verification processes.
- Achieved greater accuracy in database management by regularly updating provider records and tracking status changes.
- Ensured compliance with industry standards by regularly updating policies and procedures related to credentialing.
- Maintained a thorough understanding of accreditation standards, enabling accurate interpretation of guidelines for staff members when needed.
- Provided exceptional customer service to both internal and external stakeholders, addressing inquiries promptly and professionally.
- Contributed positively to team dynamics by fostering a collaborative and supportive work environment.
- Assisted in training new employees on proper credentialing procedures, contributing to their rapid integration into the team environment.
- Prepared records for site visits and file audits.
- Improved turnaround time for credentialing applications by implementing an efficient online system.
- Reduced errors in credentialing files by conducting thorough reviews and consistently maintaining attention to detail.
- Enhanced team collaboration by implementing centralized database for tracking credentialing statuses.
- Reduced errors in provider data management by introducing automated verification tools.
- Improved provider satisfaction with efficient handling and processing of credentialing applications.
- Facilitated training sessions for new staff on credentialing processes, improving team efficiency.
- Developed and implemented onboarding and orientation programs for new employees.
- Advocated for staff members, helping to identify and resolve conflicts.
Office Manager
Educators Financial Group
08.2021 - 06.2022
- Addressed customer concerns promptly, leading to increased satisfaction.
- Fostered team collaboration by initiating regular team meetings.
- Established streamlined procedures for document management for enhanced accessibility.
- Enhanced relationships with stakeholders using proactive engagement strategies.
- Optimized office budget by renegotiating vendor contracts.
- Handled sensitive information with discretion, maintaining confidentiality of company documents and personnel records.
- Provided exceptional customer service when addressing client inquiries or concerns via phone calls or email correspondence.
- Oversaw office inventory activities by ordering and requisitions and stocking and shipment receiving.
- Enhanced team productivity by delegating tasks effectively and overseeing daily workflow.
- Streamlined office operations by implementing efficient filing systems and organizational strategies.
- Assisted in the recruitment process, conducting interviews and onboarding new employees to promote a seamless integration into the team dynamic.
- Managed vendor relationships, negotiating contracts for cost savings while maintaining high-quality services.
- Oversaw facility maintenance requests, coordinating with building management to address repairs or improvements efficiently.
- Coordinated with IT department to upgrade office technology, enhancing overall efficiency and data security.
- Streamlined document handling and processing, reducing turnaround time for client inquiries and requests.
- Increased customer satisfaction by developing effective client feedback system that led to service improvements.
- Reduced overhead costs significantly through negotiation of vendor contracts for office supplies and services.
- Implemented comprehensive training program for new hires, improving their integration into team and productivity.
- Assisted in organizing and overseeing assignments to drive operational excellence.
- Leveraged data and analytics to make informed decisions and drive business improvements.
Office Manager
Sunset Hospice
11.2020 - 05.2021
- Addressed customer concerns promptly, leading to increased satisfaction.
- Established streamlined procedures for document management for enhanced accessibility.
- Enhanced relationships with stakeholders using proactive engagement strategies.
- Optimized office budget by renegotiating vendor contracts.
- Monitored expenditures for better financial control.
- Handled sensitive information with discretion, maintaining confidentiality of company documents and personnel records.
- Provided exceptional customer service when addressing client inquiries or concerns via phone calls or email correspondence.
- Maintained accurate financial records by reconciling accounts payable/receivable transactions regularly to ensure balanced budgets.
- Oversaw office inventory activities by ordering and requisitions and stocking and shipment receiving.
- Conducted regular inventory assessments of office supplies, ordering necessary items proactively to prevent stock shortages.
- Assisted in the recruitment process, conducting interviews and onboarding new employees to promote a seamless integration into the team dynamic.
- Served as a liaison between upper management and staff members, facilitating open channels of communication to address concerns or issues promptly.
- Facilitated smooth communication between departments, addressing concerns promptly to maintain harmonious work relationships.
- Supported department heads in accomplishing their goals through diligent administrative assistance such as report generation and data entry.
- Oversaw facility maintenance requests, coordinating with building management to address repairs or improvements efficiently.
- Contributed to workplace safety by ensuring compliance with established emergency protocols and conducting regular equipment inspections.
- Enhanced communication within office by implementing centralized digital messaging platform.
- Facilitated smooth office relocations by meticulously planning and coordinating all aspects of move.
- Conducted regular reviews of office procedures, identifying and implementing improvements for operational excellence.
- Enhanced office operational efficiency by streamlining filing systems, resulting in easier access to critical documents.
- Facilitated positive work environment, addressing employee concerns promptly and fostering culture of mutual respect.
- Streamlined document handling and processing, reducing turnaround time for client inquiries and requests.
- Optimized office space utilization, leading to more efficient and productive work environment.
- Reduced overhead costs significantly through negotiation of vendor contracts for office supplies and services.
- Reduced environmental impact by initiating recycling program and promoting paperless processes.
- Managed scheduling and coordination of all office meetings to ensure smooth operations and minimal conflicts.
Credentialing Coordinator
Prime Healthcare Group
08.2015 - 06.2016
- Tracked expiration dates of licenses and certifications to initiate timely renewals for providers.
- Managed credentialing process by verifying provider qualifications and background checks.
- Trained new staff on credentialing processes and software to foster knowledgeable team environment.
- Collaborated with healthcare providers to gather necessary documentation for credentialing applications.
- Implemented credentialing policies to align with regulatory requirements and organizational standards.
- Streamlined the credentialing process by implementing an efficient tracking system for medical staff applications.
- Minimized potential legal complications by ensuring adherence to federal and state regulations governing healthcare practitioners'' licensure and certification requirements.
- Communicated effectively with various parties each day using polished interpersonal and active listening skills.
- Contributed to risk management initiatives by monitoring expiring licenses, certifications, and insurances, notifying providers of renewal requirements in a timely manner.
- Increased efficiency in data management by implementing a user-friendly database system for storing provider information.
- Coordinated continuing education opportunities for medical staff, promoting professional growth and development among affiliated providers.
- Improved turnaround times for processing credentials by diligently reviewing and verifying provider eligibility.
- Boosted productivity levels within the credentialing team by training new employees on proper procedures and best practices within the role.
- Tracked expiration dates on documents and communicated with appropriate staff to avoid late filing.
- Served as a resource for departmental staff by maintaining a thorough understanding of current trends and best practices in the credentialing field.
- Upheld strict confidentiality standards, safeguarding sensitive provider information from unauthorized access or disclosure.
- Strengthened relationships with external agencies by responding promptly to verification requests and inquiries regarding providers'' credentials.
Education
No Degree - Communications
Brookdale Community College
Lincroft, NJSkills
- HIPAA compliance
- Provider enrollment
- Background checks
- Data management
- Credentialing oversight
- Application management
- Document review
- Regulatory compliance
- Database maintenance
- Training and mentoring
- Organizational development
Certification
- Compensation Management Specialist (CMS) - International Foundation of Employee Benefit Plans.
- Healthcare Compliance Certification Program (HCCP) - Health Care Compliance Association.
- NAMSS - 2016
Timeline
Credentialing Specialist
AmeriHealth Caritas
06.2023 - Current
Office Manager
Educators Financial Group
08.2021 - 06.2022
Office Manager
Sunset Hospice
11.2020 - 05.2021
Credentialing Coordinator
Prime Healthcare Group
08.2015 - 06.2016
No Degree - Communications
Brookdale Community College
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