Experienced Credentialing Specialist adept at conducting application reviews and primary source verifications. Excellent relationship-building, problem-solving and communication skills.
Overview
5
5
years of professional experience
Work History
Contractual Credentialing Specialist
Development Centers
08.2020 - Current
Conducted primary source verifications such as background checks and board certifications.
Received and evaluated applications for missing and inaccurate information.
Received, reviewed and verified submitted documentation needed for the credentialing process.
Obtained CAQH numbers for providers and updated existing profiles.
Enrolled providers in Medicaid, Medicare and private insurance plans.
Obtained NPI numbers for providers and facilities and updated existing profiles.
Claims Examiner
Total Medical Staffing
04.2019 - 04.2020
Reviewed new insurance claims to determine current status of injury and to develop plan of action.
Collaborated with claims department to resolve claims for adjudication.
Conducted day-to-day administrative tasks to maintain information files and process paperwork.
Credentialing Assistant
Robert Half Agency
04.2017 - 01.2019
Received and evaluated applications to look for missing and inaccurate information.
Conducted primary source verifications such as background checks and board certifications.
Enrolled providers and Medicaid, Medicare and private insurance plans.
Obtained NPI and CAQH numbers for providers and facilities and updated existing profiles.
Education
Bachelor of Science - Healthcare Administration
University of Phoenix
Southfield
Skills
Procedures Compliance
Internal Communications
Employment Recordkeeping
Collection and verification of new hire applications and documents
Council for Affordable Quality Health Care (CAQH) application requirements
National Provider Identifier (NPI) applications and revisions