Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Tunrayo Taiwo

Houston

Summary

Dynamic Lead Credentialing Specialist with a proven track record in managing compliance and expediting processes. Skilled in client relationship management and utilizing credentialing software. Recognized for fostering team collaboration and enhancing operational efficiency, ensuring timely completion of credentialing tasks while maintaining strict confidentiality.

Overview

8
8
years of professional experience
1
1
Certification

Work History

Lead Credentialing Specialist

RLDatix
11.2023 - Current
  • Ability to work under minimal direction, think logically in solving assigned problems, and present recommendations with clarity in written and graphic form.
  • Provide regular and timely status updates to the team and leadership, as needed, to ensure that applications meet the agreed-upon timeline.
  • Foster effective working relationships with all team members.
  • Gathering, analyzing, and disseminating information to the team to maintain progress.
  • Maintain up-to-date knowledge of regulatory requirements and industry standards.
  • Provide training and support to new staff on credentialing and client nuances consistently.
  • Collaborate with medical staff to gather the necessary documentation for credentialing.
  • Expedite the onboarding process for new providers, ensuring the timely completion of all required documentation and verifications.
  • Manage credentialing processes for multiple healthcare clients, ensuring compliance with regulatory standards.
  • Lead a team of specialists, providing training, support, and performance evaluations.
  • Serve as a point of contact for clients, addressing concerns, and providing regular updates.
  • Review and verify provider applications for accuracy and compliance.
  • Utilize electronic systems to track and manage credentialing information securely.
  • Ensure the timely completion of credentialing processes by guiding providers on the required documentation.
  • Perform primary source verifications, such as criminal histories, licenses, and board certifications.
  • Process re-credentialing applications for existing providers according to contractual requirements.
  • Maintain informational resources, tracking, and documenting requests for updates, certification, and credentialing.
  • Research discrepancies between submitted provider data and verified sources when necessary.

Credentialing Specialist

Elevance Health
11.2020 - 11.2023
  • Conducted primary source verifications such as background checks and board certifications.
  • Received and evaluated applications to look for missing and inaccurate information.
  • Obtained NPI numbers for providers and facilities and updated existing profiles.
  • Enrolled providers and Medicaid, Medicare and private insurance plans.
  • Tracked expiration dates on documents and communicated with appropriate staff to avoid late filing.
  • Maintained accurate files, records and credentialing documents in well-maintained databases using Sharepoint.
  • Coordinating, processing and completing credentialing functions of all Providers in accordance with NCQA, State and Federal requirements
  • Participated in development of internal credentialing processes
  • Monitoring progress and completion of all sites visit by Provider Network Team to ensure
    completion within established timeframe
  • Entered into record-keeping systems appropriate data needed to create new records or update existing ones.
  • Completed field checks to verify licenses and permits for various business.
  • Validates discrepancies and ensures appropriate follow up by contacting practitioners to clarify
    discrepancies.
  • Reviewed provider documents to promote compliance with quality and regulatory standards.
  • In charge of preparing and providing information for internal and external customers as appropriate. Filled individual provider files and applications with up-to-date information
  • Completed revalidation requests and re-credentialing of over 200
    applications monthly while updating provider database documents and profiles according to preset schedules.

Credentialing Specialist

Humana
08.2018 - 11.2020
  • Collected and analyzed information to monitor compliance outcomes and identify and address trends of non-compliant behavior.
  • Assisted senior management with making key decisions by developing and submitting performance and reports with status updates and improvement recommendations.
  • Received, recorded and addressed incoming and outgoing communication via telephone and email.
  • Organized provider files and streamlined operations to improve efficiency.
  • Completed administrative provider intakes with case histories, insurance information and mandated forms.
  • Increased office productivity by transcribing over 10 daily meetings and appointments and implementing organizational systems for documents.
  • Registered and verified patient records before triage with most up-to-date information.
  • Quickly learned new skills and applied them to daily tasks, improving efficiency and productivity.
  • Carried out day-day-day duties accurately and efficiently.
  • Demonstrated respect, friendliness and willingness to help wherever needed.
  • Supported investigations with evidence gathered while processing application- including documentation,digital records, and personnel statements.
  • Ensured credentials submitted are legitimate Primary source credential verification.
  • Compiled, researched, and screened all Providers via NPDB, IRS Interactive TIN, Health Guide USA,
    NPI Registry, APA, and other online resources while maintaining working knowledge of all computer applications needed including facility specific credentialing software database, Word, Excel and PowerPoint (as applicable).
  • Performed duties in accordance with applicable standards, policies and regulatory guidelines to promote safe working environment.
  • Maintained energy and enthusiasm in fast-paced environment.
  • Initiated follow-up communications required to adequately research and secure information necessary to facilitate credentialing goals.
  • Maintained strict confidentiality with regard to protected health information.
  • Maintained current knowledge of medical staff bylaws, rules and regulations, policies and procedures and credentialing requirements.
  • Reviewed applications and other data sources for accuracy and completeness.
  • Served as resource for physicians in credentialing and privileging process.
  • Received and evaluated applications to look for missing and inaccurate information.

Licensed Insurance Sales Representative

Progressive
05.2017 - 08.2018
  • Engaged with customers to effectively build rapport and lasting relationships.
  • Solved customer challenges by offering relevant products and services.
  • Increased sales up to 15% by offering advice on purchases and promoting additional products.
  • Maintained customer satisfaction with quick and professional handling of product returns.
  • Processed product returns and assisted customers with other selections.
  • Implemented up-selling strategies such as recommending accessories and complementary purchases to boost revenue.
  • Maintained records related to sales, returns and inventory availability.
  • Grew sales and boosted profits, applying proactive management strategies and enhancing sales training.
  • Sold auto, home, life and other various insurance products to individuals and affinity groups within assigned territory using consultative selling techniques.
  • Stayed in touch with clients to assess changing demands and offer new solutions.
  • Generated sales by recommending policies and add-ons.
  • Customized existing insurance programs to suit individual client needs by analyzing specific requirements.
  • Reviewed policy applications for errors and liaised with underwriters to facilitate quick completion of application process.
  • Drove team revenue totals by bringing in top sales numbers.
  • Conducted research on insurance packages and investment options to generate client recommendations.
  • Displayed consistent, positive attitude towards customers, peers and other personnel, even during high-stress situations.
  • Finalized sales and collected necessary deposits.
  • Worked with sales team to collaboratively reach targets, consistently meeting or exceeding personal quotas.
  • Collected premiums on or before effective date of coverage.
  • Remained impartial in order to advise clients based on circumstances.
  • Collected, analyzed and validated agency commissions.

Education

Associate of Applied Science - Computer Systems Networking - Cyber Security

Houston Community College
Houston, TX
05.2018

Skills

  • Community Health Center Credentialing
  • Background Checks
  • Internal Communications
  • Reading Comprehension
  • Proficiency in Microsoft Office, CRM applications, Bank solutions application
  • Excellent written communication skills
  • Client relationship management
  • Excellent listening skills
  • Good team player and goal getter
  • Conflict resolution skills
  • Use of Cactus, Apex, SmartCred, and Verge for documentation of provider's information
  • Effective use of BPM to upload documents for provider's verification
  • Confidential Records Management
  • Data Acquisition
  • Microsoft Office
  • Americans with Disabilities Act (ADA)
  • Analytical and Critical Thinking

Certification

  • Certified Project Management Professional (PMP)
  • Licensed Insurance Agent
  • Business Analysis & Process Management
  • Microsoft Office Specialist

Timeline

Lead Credentialing Specialist

RLDatix
11.2023 - Current

Credentialing Specialist

Elevance Health
11.2020 - 11.2023

Credentialing Specialist

Humana
08.2018 - 11.2020

Licensed Insurance Sales Representative

Progressive
05.2017 - 08.2018

Associate of Applied Science - Computer Systems Networking - Cyber Security

Houston Community College

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Tunrayo Taiwo