Omolara Nureni
Richmond,TX
Summary
Accomplished Credentialing Specialist with over 5 years of dedicated experience in healthcare credentialing and regulatory compliance, showcasing a strong ability to manage provider data with precision. Adept at conducting thorough primary source verification, ensuring adherence to industry standards while streamlining processes through effective communication and collaboration. Expertise encompasses provider enrollment, re-credentialing, and maintaining meticulous records that support compliance with regulations. Committed to enhancing operational efficiency and fostering positive relationships with healthcare providers, ready to leverage skills to further the goals of a forward-thinking healthcare institution.
Experienced with credentialing processes and regulatory compliance. Utilizes effective communication and meticulous documentation to manage credentialing for healthcare providers. Knowledge of industry standards and best practices ensures thorough and efficient credentialing operations.
Overview
8
8
years of professional experience
Work History
Credentialing Specialist
St. Jude Children's Research Hospital
05.2019 - Current
- Managed the credentialing process for a diverse range of healthcare providers
- Expertly collected, validated, and maintained precise provider data, including licenses, certifications, and insurance
- Conducted thorough primary source verification, ensuring strict regulatory compliance
- Facilitated cross-functional communication to streamline the credentialing process
- Maintained impeccable provider credentialing records, adhering to industry standards and compliance requirements
- Prepared and submitted applications for provider enrollment and re-credentialing with insurance payers
- Actively engaged with healthcare providers, resolving credentialing-related inquiries and fostering positive relationships
- Monitored credentialing expiration and ensured timely renewals
- Prepared for and participated in regulatory audits by government agencies and third-party organizations
- Implemented and enforced policies and procedures to enhance efficiency, accuracy, and compliance in credentialing
- Managed approximately 30 incoming calls, emails and faxes per day from customers.
Customer Support Specialist
Kelsey-Seybold Clinic
04.2017 - 03.2019
- Assisted customers in using company products and services, ensuring a positive experience
- Managed customer accounts, processed orders, and addressed billing inquiries
- Troubleshot technical issues and provided guidance for issue resolution
- Conducted customer satisfaction surveys to gather feedback
- Contributed to the development of training materials for new hires
- Collaborated with the product development team to communicate customer feedback
- Managed approximately 25 - 30 incoming calls, emails and faxes per day from customers.
Education
Bachelor of Science - Business Administration And Management
Babcock University
Ogun, Nigeria06.2013
Skills
- Knowledge of Credentialing
- Regulatory compliance (HIPAA, CMS, NCQA)
- CAQH
- Smart Cred
- PSV Web Sites
- Symplir
- Microsoft Suites (Excel, Word, PowerPoint, Outlook)
- ServiceNow
- Healthcare credentialing and privileging
- Streamline
- Health Insurance Portability and Accountability Act Compliance
- Data management and recordkeeping
- Conflict Resolution
- Billing Processes
- Records Management
- Customer Support and Satisfaction
- Time Management
- SAP Applications
- Provider enrollment and recredentialing
- Health Care
- Regulatory Compliance
- Communication Skills
- Auditing Skills
- Microsoft Teams
- Surveys
- Attention to Detail
- Problem-solving and conflict resolution
- Team collaboration
LANGUAGES
English
Timeline
Credentialing Specialist
St. Jude Children's Research Hospital
05.2019 - Current
Customer Support Specialist
Kelsey-Seybold Clinic
04.2017 - 03.2019
Bachelor of Science - Business Administration And Management
Babcock University
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