Summary
Overview
Work History
Education
Skills
Personal Information
Volunteer Experience
Timeline
Generic

Roxanne Moore

Raleigh,NC

Summary

Experienced Credentialing Specialist adept at conducting application reviews and primary source verifications. Excellent relationship-building, problem-solving and communication skills.

Overview

18
18
years of professional experience

Work History

Credentialing Specialist

Healthfirst Management LLC
05.2016 - Current
  • Credentialing and Re-Credentialing of Physicians, Nurses and Mental Health Providers
  • Performs primary source verifications using license verification websites, OPMC, SAM, OIG, OMIG, OFAC, NPI and NPDB websites
  • Daily data entry using MACESS, MHS and Cactus Software Systems
  • Complies with NCQA compliance standards
  • Daily interactions with leadership team and director
  • Maintains CAQH applications for providers
  • Monitors day-to-day operations of credentialing functions such as follow-up telephone calls, emails and letter correspondents
  • Electronic filing, faxing, emailing and answering high volume telephone system
  • Maintains knowledge of credentialing standards and policies and procedures
  • Ensure timely distribution of approval letters to providers after committee approval
  • Maintain documentation and reports using MS Word, MS Excel, MS PowerPoint and Outlook Email Systems
  • Collection of provider contracts and Manages provider audits
  • Updates provider directory
  • Exceptional attention to detail
  • Prepares agenda for monthly Credentials Committee meeting.

Credentialing Coordinator

Hospitals for Special Surgery
09.2005 - 12.2016
  • Credentialed attending physicians, consultants and allied health professionals
  • Re-credentialed attending physicians, consultants and allied health professionals
  • Schedules meetings for Credentials Committee and Medical Board
  • Coordinates conference calls for various meetings
  • Uses data entry system CACTUS to organize attending physicians, consultant & allied health professional demographic information/credentials
  • Obtained License Registration, DEA Registration, Infection Control Certificates, Board Certifications, ACLS/BCLS Registration for Credentials File
  • Prepares documentation for Credentials Committee and Medical Board meetings
  • Complies with company statistics and data under requirements of the director
  • Complies with The Joint Commission regulations and standards
  • Filing, faxing, copying, scanning, and answers telephone system.

Education

Bachelor’s of Science in Psychology – B.S. -

University of Phoenix
06.2019

Human Services – AAHSM Associates Degree -

University of Phoenix
06.2015

High School Diploma -

Bishop Loughlin Memorial High School
06.2001

Skills

  • Data Management
  • Proofreading
  • Employee Onboarding
  • Application coordination
  • Document Review
  • Provider enrollment
  • HIPAA Compliance
  • Application management
  • Background Checks
  • Credentialing oversight
  • Management collaboration
  • Provider Relations

Personal Information

Title: Healthcare Professional

Volunteer Experience

06/15/2012, 09/01/2013, Compassionate Care Hospice, Volunteer, Brooklyn, NY, Developed activities to do with client., Reported to Social Worker the activity between the client and I., Assistants client with basic functions around living area., Assists client with errands as needed., Served as companion for client.

Timeline

Credentialing Specialist

Healthfirst Management LLC
05.2016 - Current

Credentialing Coordinator

Hospitals for Special Surgery
09.2005 - 12.2016

Bachelor’s of Science in Psychology – B.S. -

University of Phoenix

Human Services – AAHSM Associates Degree -

University of Phoenix

High School Diploma -

Bishop Loughlin Memorial High School

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