TIANA JOHNSON
Goodyear,AZ
Summary
Dynamic healthcare operations professional with over 7 years of expertise in provider credentialing, enrollment, data management, compliance, and analytics. Proven track record of achieving 100% audit performance for consecutive months, demonstrating a commitment to excellence in high-volume provider onboarding. Skilled in ensuring regulatory compliance across large healthcare organizations while optimizing operational efficiencies. Committed to leveraging data-driven insights to enhance processes and support organizational goals.
Overview
7
7
years of professional experience
Work History
Credentialing Coordinator
Banner Health
Remote
07.2025 - Current
- Manage provider credentialing and onboarding activities across multiple specialties.
- Conduct primary source verifications and ensure compliance with NCQA, CMS, payer, and organizational standards.
- Review provider applications and maintain accurate provider records in VerityStream.
- Consistently maintain audit scores above 99%.
- Streamlined application workflows to enhance efficiency and reduce processing times for credentials verification.
- Collaborated with clinical departments to address credentialing issues, facilitating timely onboarding of medical staff.
- Implemented quality control measures to verify completeness and correctness of credentialing files before submission.
- Strengthened relationships with external agencies by responding promptly to verification requests and inquiries regarding providers'' credentials.
- Conducted primary source verifications such as background checks and board certifications.
Junior Provider Analyst
Banner Health
Remote
09.2024 - 07.2025
- Maintained provider data integrity across healthcare systems.
- Collaborated with credentialing, contracting, and network management teams.
- Analyzed healthcare data to identify trends, improving patient care initiatives.
- Developed reports using advanced statistical tools to support decision-making processes.
- Reduced errors in data entry, instituting rigorous quality control checks.
- Managed multiple projects simultaneously while adhering to strict deadlines and quality standards.
Provider Resolution Specialist
TriWest Healthcare Alliance
Remote
02.2019 - 09.2024
- Streamlined claim resolution processes, enhancing accuracy and efficiency in provider communications.
- Analyzed claim discrepancies to identify root causes and implemented corrective actions.
- Conducted thorough investigations into complex claim issues, resolving disputes fairly and effectively.
- Evaluated provider contracts to ensure compliance with organizational standards.
- Developed strong relationships with providers through effective communication and timely response to inquiries, fostering trust and cooperation between parties involved.
- Resolved escalated provider issues professionally and efficiently, preventing further complications or dissatisfaction with services provided.
- Assisted management in preparing reports detailing key metrics related to provider claim resolutions, supporting informed decision-making within the organization.
Education
High School Diploma -
Skills
- HIPAA compliance
- Proficient in Microsoft Office
- Verity Stream
- Salesforce
- MSOW
- Siebel
- Records and file management
- Document review
Accomplishments
- Maintained audit scores ranging from 99.4% to 100%.
- Processed and managed 90+ provider credentialing files monthly.
- Supported provider onboarding, enrollment, and compliance initiatives across major healthcare organizations.
- 7+ years of progressive healthcare operations experience.
CORE COMPETENCIES
- Provider Credentialing
- Recredentialing
- Provider Enrollment
- Provider Lifecycle Management
- NCQA
- CMS
- Audit Readiness
- Provider Relations
- Healthcare Analytics
- Process Improvement
- Regulatory Compliance
- Primary Source Verification
- Cross-Functional Collaboration
Timeline
Credentialing Coordinator - Banner Health
07.2025 - Current
Junior Provider Analyst - Banner Health
09.2024 - 07.2025
Provider Resolution Specialist - TriWest Healthcare Alliance
02.2019 - 09.2024
Corona Del Sol High School - High School Diploma,