Summary
Overview
Work History
Education
Certification
Timeline
Generic

Tonya Graham

Mansfield,OH

Summary

Credentialing Specialist with over 17 years of dedicated experience in the field. Experienced administrative professional with 17+ years in provider credentialing services. Works productively with facilities, provider groups and individual professionals. Knowledgeable about application requirements for government and private insurance plans.

Overview

8
8
years of professional experience
1
1
Certification

Work History

Provider Network Specialist

OhioHealth
03.2024 - Current
  • Provide services to provider network offices for issues related to claims payment, product descriptions, education/training of staff, fee schedules, complaints, termination of contracts and verifying all minimum requirements to obtain a contract are maintained.

Credentialing Software Coordinator/Independent Contractor

Third Street Family Health Services
Remote
02.2024 - Current
  • Primary contact with Verity Stream (CredentialStream) throughout the implementation process
  • Develop detailed project plan on the process for software setup and migration of all data into new system for all credentialed staff.

Regulatory Specialist of Licensing and Credentialing

Somatus, Inc.
Remote
08.2023 - 01.2024
  • Monitored both initial credentialing and re-credentialing applications, ensuring a comprehensive review process
  • Oversaw the screening of practitioners' applications and supporting documentation to verify their eligibility, proactively identifying, and addressing any discrepancies.

Sr. Credentialing Specialist

OCHIN
Remote
03.2022 - 08.2023
  • Ensured the timely processing of initial credentialing and re-credentialing applications, aligning with regulatory requirements such as NCQA, HRSA/FTCA, Joint Commission, AAAHC, CMS, and other relevant standards.

Credentialing & Compliance Specialist

Equitas Health Inc
Hybrid
12.2019 - 03.2022
  • Maintained comprehensive documentation of credentialing and privileged activities, serving as the Equitas Health Credential My Doc administrator, our provider and payer credentialing software provider.

Credentialing Coordinator

Advanced Billing & Consulting Services
Hybrid
12.2018 - 12.2019
  • Managed all aspects of credentialing and re-credentialing for medical and behavioral health professionals, serving as the primary point of contact for provider, group, and facility credentialing/re-credentialing.

Credentialing Services Manager

Riverside Radiology & Interventional Associates
Columbus, OH
06.2017 - 10.2018
  • Spearheaded the meticulous credentialing process for both initial and reappointment applicants, ensuring accurate and timely coordination in alignment with predefined schedules.

Credentialing Manager

Hometown Urgent Care
Columbus, OH
03.2016 - 05.2017
  • Orchestrated the systematic collection of data pertinent to provider credentialing, contracting, and performance, maintaining the confidentiality of provider files.

Education

Bachelor of Science in Organizational Management -

Wilberforce University
Wilberforce, OH

Certification

CPCS (Certified Provider Credentialing Specialist), 11/2014, 12/2026

Timeline

Provider Network Specialist

OhioHealth
03.2024 - Current

Credentialing Software Coordinator/Independent Contractor

Third Street Family Health Services
02.2024 - Current

Regulatory Specialist of Licensing and Credentialing

Somatus, Inc.
08.2023 - 01.2024

Sr. Credentialing Specialist

OCHIN
03.2022 - 08.2023

Credentialing & Compliance Specialist

Equitas Health Inc
12.2019 - 03.2022

Credentialing Coordinator

Advanced Billing & Consulting Services
12.2018 - 12.2019

Credentialing Services Manager

Riverside Radiology & Interventional Associates
06.2017 - 10.2018

Credentialing Manager

Hometown Urgent Care
03.2016 - 05.2017

Bachelor of Science in Organizational Management -

Wilberforce University

Similar Profiles

CREATE PROFILE
Tonya Graham