Nyeisha Bryant
California City,CA
Summary
Experienced Credentialing Specialist adept at conducting application reviews and primary source verifications. Excellent relationship-building, problem-solving and communication skills. Work productively with facilities, provider groups and individual professionals. Knowledgeable about application requirements for government and private insurance plans.
Overview
19
19
years of professional experience
Work History
Credentialing Specialist
Right Sourcing/AmeriHealth Caritas
04.2024 - Current
- Validate completeness of practitioners and organizational providers applications to ensure all criteria is up to date
- Confirm credentials and primary source verification for all initial, re-credentialing, and organizational providers, educational institutions, licensing boards, and certification agencies through Andros verification website
- Maintain and update credentialing database by entering all critical data elements of the provider applications into S-Providers Credentialing system
- Monitor the completion of the credentialing file for completeness and accuracy while following HIPPA and PHI requirements
- Ensure data from Andros aligns with provider and telehealth providers, and facilities, the CAQH application, roster, and/or intake form to ensure that all files are complete and up to date to further the credentialing process and internal audit
- Verify provider and facilities tax id, NPI, Medicaid, and Medicare number, and if applicable CLIA to match providers primary practice location address.
- Run daily reports.
- 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.
- Obtained NPI numbers for providers and facilities and updated existing profiles.
- Updated and maintained accurate records in credentialing databases, ensuring timely renewals and verifications.
Paraprofessional
Mojave Unified School District
01.2020 - 09.2021
- Work with children that have autism spectrum disorders and behavior disorders
- Worked remotely- arranged lesson outlines via Zoom and individual plans according to the classroom course syllabus and district requirements
- Monitored student’s computer usage, assisted students with hardware and software issues
- Attended services, workshops, trainings, and seminars
- Assisted implementation of students individual IEP at discretion and direction of teacher and administrators
- Document student behavior to notate on the IEP regarding the students’ progress and behavior
- Assisted student by providing one-on-one instructional support.
Food Service Worker
Mojave Unified School District
08.2018 - 01.2020
- Demonstrated knowledge of menu items and ingredients
- Complied with company standards and adhered to inventory and cash control procedures
- Acquired new skills to support team and further accommodate customers’ needs
- Maintained order and cleanliness of work areas to conform with health codes.
Credentialing Specialist
Health Net Inc.
07.2005 - 11.2012
- Ability to manage complex organizational arrangements, documentation, and requests from multiple committees and/or individuals
- Maintain confidentiality of documents and sensitive information while adhering to PHI and HIPAA laws
- Processed documents and status change requests, conduct follow-up assessments regarding enrollment inquiries
- Ensures incoming applications are completely timely and analyzes primary source verification, identify potential adverse events, requiring additional supporting documentation and data entry
- Developed and maintained effective working relationships with providers, staff, and other stakeholders
- Tracks and maintains all provider licensure, DEAs, and certifications
- Updates credentialing software systems with required information.
- Conducted audits of provider files, ensuring all necessary documents were up-to-date and compliant with regulatory requirements.
- Conducted primary source verifications such as background checks and board certifications.
Education
BBA - Business
University of Phoenix
Associates of Science Degree in Business Administration -
San Joaquin Valley College
06.2002
Skills
- Attention to detail
- Analytical skills
- Public speaking
- Microsoft Office
- Problem Solving Skills
- Critical Thinking Skills
- Principles of Human Resources
- Human Resource Administration
- Written Communication
- Adaptability
- Team Player
- Data Management
- Credentialing oversight
- Provider Relations
Phone - Mobile
(661) 889-8394
Timeline
Credentialing Specialist
Right Sourcing/AmeriHealth Caritas
04.2024 - Current
Paraprofessional
Mojave Unified School District
01.2020 - 09.2021
Food Service Worker
Mojave Unified School District
08.2018 - 01.2020
Credentialing Specialist
Health Net Inc.
07.2005 - 11.2012
BBA - Business
University of Phoenix
Associates of Science Degree in Business Administration -
San Joaquin Valley College
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