Selundria Wilson
Lithia Springs,GA
Summary
Experienced Credentialing Specialist adept at conducting application reviews and primary source verifications. Excellent relationship-building, problem-solving and communication skills.
Overview
17
17
years of professional experience
1
1
Certification
Work History
LEAD CREDENTIALING SPECIALIST
Medely, Inc
11.2021 - 01.2024
- Monitoring Nursys Reports Quality Assurance(Audits for Recruitment Team as well as Merely, Reviewing/Uploading Drug Tests, Maintaining team email inboxes, Monitoring, gathering and uploading expiring credentials for professionals on assignments, Processes initial applications and reappointment's for hospitals/centers for assigned providers, Onboard all new hires in Sapling, Maintains complete file for providers licensure and credentials, Monitors renewals of licensure and forwards copies of licensure to facilitates as renewals are received, Maintains and updates continuing medical education/BLS,ACLS, PALS and other training requirements, Maintains and updates annual PPD,TB,CXR, FLU immunization records and forward to facilities, Maintains and updates HEPB, TDap, MMR and Varicella immunizations and forward copies to facilities, Monitoring Competency review documents, assisting with compliance support questions in Slack, Maintaining Travel Credentials, Communication with Travel VMS Coordinators, Communicating with professionals and travelers as needed, Ensuring travel credentialing deadlines are met, Maintenance of physician enrollment and CAQH profiles, Prepared records for site visits and file audits, Reviewing and processing provide applications with regulatory and client defined timelines while evaluating for accuracy and completeness, Conduct primary source verifications such as a background checks and board certifications, Tracking and updating any potential discrepancies through all forms of communication, Organize and participate in virtual client meetings for provider application status and/or any discrepancies that have been uncovered, Audit and assign work
OPERATIONS ADMINISTRATOR
Allyon, Inc
10.2020 - 07.2021
- Recruit and identify candidates for open positions through various channels, including internal position responses, referrals, internet tools, direct recruiting, job fair etc, Monitor and manage onboarding processes, Keying new hire information into the payroll system, Verify/Approve timecards for invoicing and timekeeping purposes, Communicate with current employees for follow up regarding timecards, PTO/time-off requests, Communicate with external employees regarding payroll documents or any other new hire requirements to complete personnel files prior to start dates, Update new hire information by way of notes on candidate profiles in the ATS, Initiate benefits enrollment, Update benefits elections in benefits portal and payroll portal, Assist employees with travel arrangements, Communicate with vendors to extend reservations, place orders, update orders, Process employee expenses for reimbursement, Verify Credit Card Statements and reconcile accounts, Assist with corporate culture activities as needed, such as event planning, life event celebrations, and employee satisfaction initiatives
VERIFICATION SPECIALIST TEAM LEAD
Advanced Infusion Solutions
03.2018 - 09.2020
- Assists with screening applicant/resumes, coordinating phone/in-person interviews, Recognizes patients' rights and responsibilities and supports them in performance of job duties: respects patient's rights to privacy and confidentiality, Verifies health insurance coverage and benefits for assigned payers etc., Humana Cigna, Blue Cross Blue Shield, commercial, worker's compensation, and government/state insurance plans and determines patient's responsibility, Ensure claims are processed consistently, Enters insurance information in CPR+ and notifies home office of any IV and high dollar drug and of coverage and benefits, Review credentialing and re-credentialing files; obtain all primary source verifications and present completed compliant files to region for review, Determines if pre-certification or prior authorization is required for insurance company, Follows up on pending or expired authorizations, Documents, in detail, phone calls, phone numbers, person spoken to and call details on a consistent basis, Maintains a thorough understanding for NDC (Nations Drug Code) numbers, billing units, metric quantities etc, Maintains a broad range of knowledge of insurance plans, medical terminology, billing procedures, government, and medical codes such as CPT and ICD-p coding, Shares knowledge gained with other staff members and works as a team member interacts with others in a positive, respectful, considerate manner and performs other job related duties.
PROVIDER ENROLLMENT CREDENTIALING SPECIALIST TEAM LEAD
Conduent
01.2016 - 02.2018
- Assists with screening applicant/resumes, coordinating phone/in-person interviews, Assists senior recruiting staff with job fairs, Prepare recruitment materials and post jobs to appropriate job boards/newspaper/colleges, Credentialing specialists maintain regular cooperation and compliance with all regulatory, accrediting, and membership-based organizations, Create and carry out various credentialing processes in relation to physicians, medical assistants, and various other healthcare professionals, Ensures that all personnel and services adhere to facility and staff policies, department guidelines, regulations, and government laws, Collect and process significant amounts of verification and accreditation information, and thus must constantly maintain and update accurate databases for both practitioners and facilities, These databases include pertinent education, training, experience, and licensure content, Prepares their own records for regular auditing, as well as maintain close communication with all appropriate practitioners to ensure that records are up-to-date and consistent, Review credentialing and re-credentialing files; obtain all primary source verifications and present completed complaint files to region for review, Generate weekly/monthly/quarterly/annual reports for regions, Update all databases with deliverables for delegates, Update and maintain all Credentialing department manuals, Processes credentialing and re-credentialing applications of health care providers, Contacts medical office staff, licensing agencies, and insurance carriers to complete credentialing and re-credentialing applications
ADMINISTRATIVE ASSISTANT IV
Division of Medicaid, Maternal, Child Health
08.2006 - 05.2015
- Assumed responsibility for a Medicaid eligibility determination caseload for a designated territory within a region, Investigated and verified accuracy of information provided by recipients under the Medicaid programs to determine compliance with State and Federal laws, rules and regulations, Determined an applicant's eligibility for institutional care based on Stated and Federal guidelines and verifies the accuracy of information listed on the applicant's applicants, Maintained good public relations and customer service, Collects eligibility data information, Reviewed existing work procedures and revise as necessary, Assigned, planned, reviewed, and coordinated the activates of staff over which supervision is exercised, Answers correspondence concerning operation of the department, Verified, records, and files claims, reports and other documents, Exercised leadership qualities to perform all phases of programs within the bureau, Performs a variety of administrative tasks dealing with fiscal management, strategic planning, legal compliances, and required reports related to the agency, Performs general clerical functions in assistance to the administrative superior which requires operating general office equipment, Organizes and schedules meetings, Maintains calendar of events and personal agendas, Maintains department/program files and records
Education
High School Diploma -
Callaway High School
Bachelor of Science -
Jackson State University
Skills
- Data Acquisition
- Problem Resolution
- Provider Enrollment
- Credential Verification
- Provider Relations
Certification
CPCS in progress
Timeline
LEAD CREDENTIALING SPECIALIST
Medely, Inc
11.2021 - 01.2024
OPERATIONS ADMINISTRATOR
Allyon, Inc
10.2020 - 07.2021
VERIFICATION SPECIALIST TEAM LEAD
Advanced Infusion Solutions
03.2018 - 09.2020
PROVIDER ENROLLMENT CREDENTIALING SPECIALIST TEAM LEAD
Conduent
01.2016 - 02.2018
ADMINISTRATIVE ASSISTANT IV
Division of Medicaid, Maternal, Child Health
08.2006 - 05.2015
High School Diploma -
Callaway High School
Bachelor of Science -
Jackson State University
CPCS in progress
Similar Profiles
Selundria WilsonSelundria Wilson
Lead Credentialing Specialist at Medely, IncLead Credentialing Specialist at Medely, Inc
Chalyssa WyrickChalyssa Wyrick
CNA - Certified Nursing Assistant- Independent Contractor at APN Staffing/Nurseio/Medely/Clipboard/NursaCNA - Certified Nursing Assistant- Independent Contractor at APN Staffing/Nurseio/Medely/Clipboard/Nursa
John HernandezJohn Hernandez
Clinic RN, Per Diem at MedelyClinic RN, Per Diem at Medely