Summary
Overview
Work History
Education
Skills
Certification
Accomplishments
Core Strengths And Skills
Timeline
Generic

Yasheka Walker

Dallas

Summary

Detail-oriented Provider Credentialing Specialist with 8 years of experience in provider enrollment, credentialing, and compliance support. Proven expertise in primary source verification, credentialing database management, and ensuring compliance with NCQA, CMS, and HIPAA standards. Adept at streamlining credentialing processes, reducing approval times, and maintaining accurate provider data to enhance operational efficiency and provider relations.

Overview

9
9
years of professional experience
1
1
Certification

Work History

Sr. Clinical Administration Coordinator

United Healthcare
Remote
06.2024 - 10.2024
  • Managed over 40 provider communications daily, addressing credentialing inquiries and updating provider data
  • Conducted outbound calls for Health Risk Assessments, ensuring accuracy in provider and patient data within EHR systems
  • Provided credentialing and compliance support, ensuring providers fulfilled licensing and enrollment requirements

Provider Contracting Associate

United Healthcare
Remote
02.2021 - 05.2024
  • Processed over 100 provider enrollment applications monthly, ensuring accuracy and compliance with NCQA and CMS guidelines
  • Conducted primary source verification of medical licenses, board certifications, DEA, malpractice history, and other credentials
  • Maintained provider records in credentialing databases such as CAQH, Epic, Facets, and Salesforce
  • Collaborated with medical staff offices, payers, and providers to resolve credentialing issues and ensure timely approval

Provider Data Specialist – Behavioral Health

United Healthcare
Remote
04.2019 - 01.2021
  • Maintained and updated provider records in credentialing databases, ensuring compliance with NCQA and CMS standards
  • Audited provider information to verify credentialing accuracy, enhancing data quality for claims processing
  • Generated reports using credentialing software to assist leadership in decision-making and compliance tracking

Member Services Representative

Blue Cross and Blue Shield of Louisiana
Shreveport
02.2017 - 06.2018
  • Resolved provider and member inquiries, ensuring compliance with state and federal healthcare regulations, contributing to a 96% customer satisfaction rate
  • Enhanced provider relations by effectively addressing contract disputes and enrollment issues

Patient Access Representative (Ambulatory Center)

University Health Hospital
Shreveport
06.2015 - 02.2017
  • Verified insurance eligibility, pre-authorizations, and patient registration, ensuring billing efficiency and compliance
  • Managed confidential provider records, maintaining HIPAA compliance and accurate documentation
  • Facilitated streamlined patient access processes, contributing to improved operational efficiency

Education

Bachelor of Science - Healthcare Administration

Charter Oak State College
New Britain, CT
05.2025

Certificate Provider Credentialing Specialist -

Charter Oak State College
New Britain, CT
12-2024

Associate of Arts - Humanities

Southern University at Shreveport
Shreveport, LA
05.2023

Skills

  • Provider credentialing
  • Electronic health records
  • Problem solving
  • Attention to detail
  • Data entry
  • Microsoft Access

Certification

Certified Provider Credentialing Specialist (CPCS), Charter Oak State College, 12/01/24

Accomplishments

  • Processed 100+ provider enrollment applications monthly, ensuring compliance with NCQA and CMS guidelines while reducing processing errors.
  • Resolved credentialing and contracting issues, improving provider approval timelines and maintaining up-to-date credentialing databases (CAQH, Epic, Facets, Salesforce).
  • Managed daily communications with 40+ providers, addressing credentialing inquiries and ensuring seamless provider data updates.

Core Strengths And Skills

  • Provider Enrollment & Credentialing
  • Primary Source Verification
  • NCQA, CMS, HIPAA Compliance
  • Credentialing Database Management (CAQH, PECOS, Availity, QNXT)
  • Contract & Credentialing Documentation
  • Microsoft Office Suite (Word, Outlook, Excel, Visio, Teams)
  • Relationship Management & Communication
  • Process Optimization

Timeline

Sr. Clinical Administration Coordinator

United Healthcare
06.2024 - 10.2024

Provider Contracting Associate

United Healthcare
02.2021 - 05.2024

Provider Data Specialist – Behavioral Health

United Healthcare
04.2019 - 01.2021

Member Services Representative

Blue Cross and Blue Shield of Louisiana
02.2017 - 06.2018

Patient Access Representative (Ambulatory Center)

University Health Hospital
06.2015 - 02.2017

Bachelor of Science - Healthcare Administration

Charter Oak State College

Certificate Provider Credentialing Specialist -

Charter Oak State College

Associate of Arts - Humanities

Southern University at Shreveport
Yasheka Walker