Credentialing Analyst Resume Sample
Amani Daugherty
70386 Austyn Forge,
Houston,
TX
+1 (555) 980 4756
Work Experience
Senior Credentialing Analyst
07/2017
-
PRESENT
New York, NY
- Provide Technical Software support for application used for provider credentialing/enrollment in coordination with information services
- Compile and analyze data as well as for creating meaningful appplications to support executive decision making, including monthly and yearly reporting
- Coordinates all delegated credentialing activities to include delegated spreadsheet with PENN Medicine CVO
- Develop reports for follow-up team to use for payer confirmations and provides assistance and direction
- Update payer applications for automatic input of information into PDF’s for OneApp or other software
- Provides training to new and current staff on all software and web based applications
- Remains knowledgeable of change to software and web based credentialing applications including, but not limited to, OneApp, Echo, CAQH, PECOS, PROMISE and Navinet
- Update provider enrollment starnet page with current information and documents
- Supports the manager of credentialing and reimbursement with productivity and Quality Assurance reporting
Credentialing Analyst
08/2012
-
05/2017
Dallas, TX
- Conducts payer provider roster audits and creates quarterly rosters for all contracted payers to meet CMS guidelines
- Experience in payer enrollment
- Experience in using credentialing software and appropriately trained
- Create reports, queries, and documents from credentialing software
- Excellent analytical and problem solving skills with the ability to make independent decisions
- Strong organization skills with great attention to details
- Strong clerical support to include data entry, documentation of procedures, faxing, scanning etc
NV MCD Credentialing Analyst
07/2008
-
06/2012
New York, NY
- Maintain confidential records and data, including but not limited to sensitive security information, personnel contact information, background check submittal information and employer information
- Gathers data, updates systems and prepares reports
- Evaluates and streamlines administrative processes
- Communicates with internal personnel as well as external job applicants
- Adhere to all company and department employment policies regarding security and confidentiality
- Administrative secretarial experience preferably in hospital/medical staff background
- Detail oriented and able to work independently, have excellent communication, organizational and computer skills
- Maintains emotional stability and a calm disposition, and has ability to relate positively with all levels of staff and medical staff professionals
Education
Antioch University Seattle
2003 - 2007
Bachelor's Degree in Management
Professional Skills
- Work as part of a team with excellent interpersonal skills
- Strong attention to detail, time management, and organization skills
- Strong interpersonal skills, ability to work as part of a team
- Skills: Planning, organizing, problem-solving and decision making
- Demonstrated skill sets in medical staff privileging/credentialing and health sciences risk management
- Applies concept of continuous improvement to develop new skills during changing initiatives
- Proficient PC skills, including Excel, Word, and other Microsoft Office products
How to write Credentialing Analyst Resume
Credentialing Analyst role is responsible for microsoft, word, software, computer, medical, health, organization, analytical, credit, training.
To write great resume for credentialing analyst job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Credentialing Analyst Resume
The section contact information is important in your credentialing analyst resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Credentialing Analyst Resume
The section work experience is an essential part of your credentialing analyst resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous credentialing analyst responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular credentialing analyst position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Credentialing Analyst resume experience can include:
- Flexible team player who thrives in production environments requiring ability to effectively prioritize and juggle multiple concurrent activities
- Excellent computer skills including Microsoft Word, Excel, and internet-based applications. Ability to maintain strictest level of confidentiality
- Strong communication skills with all levels of staff and personnel
- Professional and effective interaction skills with co-workers, clients, Providers and vendors
- Proficient PC skills, including MS Office products and internet search engines
- Analytical skills to receive, assemble and report on data records
Education on a Credentialing Analyst Resume
Make sure to make education a priority on your credentialing analyst resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your credentialing analyst experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Credentialing Analyst Resume
When listing skills on your credentialing analyst resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical credentialing analyst skills:
- Flexible team player who thrives in production environments requiring the ability to effectively prioritize and juggle multiple concurrent activities
- Good communication (both written and verbal) and presentation skills
- Proficient PC skills including Excel, Word and other MS Office products
- Word processing skills,
- Experience in Provider Enrollment and Revalidation
- Effectively communicate with internal colleagues and external clientele
List of Typical Experience For a Credentialing Analyst Resume
1
Experience For Senior Credentialing Analyst Resume
- Experience working in a Credentialing Analyst capacity
- Meet deadlines, prioritize work and a self-starter
- Establishes electronic reporting and monitoring for the Revenue Cycle area, including data submission, follow-up, and reporting findings to management
- Provide support with system training with new and existing staff
- Review and approve accounts based on established guidelines including review of required documentation and artifacts
- Perform in a repetitive manner while remaining focused on details
- Sound judgment in weighing risk, legal and compliance requirements
2
Experience For Temporary Credentialing Analyst Resume
- Input and update the Salesforce Credentialing database and Web Portal
- Audits the charge capture process and billing activities for the Moffitt Medical Group physicians
- Analytical ability to gather and summarize data
- Process detailed information with accuracy
- Evaluates and streamlines processes
- Accurately perform data entry of all primary source verifications and select provider demographic and practice location information into Optum’s Long Term Services & Supports Management System (LTMS) & MassHealth’s MMIS System
- Assist the Credentialing Manager with the preparation and submittal of Managed Care credentialing applications
3
Experience For NV MCD Credentialing Analyst Resume
- Perform regular follow up on the status of applications in process with Payors and update the status in Salesforce or similar CRM platform
- Update and maintain all Managed Care spreadsheets and distribute to Managed Care team
- Formulates, defines and recommends scope and format of reports
- Assist with projects as assigned by manager
- Identify trends through analysis of metrics
- Identify vulnerabilities and propose mitigation strategies through interaction with appropriate stakeholders
- Handle intermediate escalations and remediation cases
4
Experience For Onsite Credentialing Analyst Resume
- Communicate regularly with management on productivity reviews
- Analyze new and current customer data suppliers/consumers in order to ensure fraudulent data is not submitted to Equifax, and the use of Equifax data meets established permissible purposes
- Analyze issues, identify solutions and communicate effectively with stakeholders
- Conduct web site reviews, where appropriate, when auditing cases and escalation matters
- Understand and implement current regulatory, compliance, legal and security requirements
- Review and analyze current client data based upon established guidelines
5
Experience For Onsite Credentialing Analyst Telecommute Resume
- Acquire, review, document and save all information obtained from the investigation
- Preparation and submission of weekly metrics
- Basic data manipulation in Excel
- OMA Credentials Systems Improvement/Maintenance: Identifies and documents needed improvements and maintenance reports for all commercial and internally-developed OMA systems for follow-up by the OMA development team, and provides credentialing expertise as content expert through the development and implementation processes
- Ad hoc projects as directed by manager, e.g. training new staff in the credentialing process, maintaining the CVO Operations Manual, analyzing operating performance data, etc
- Communicate with Network Management and Contracting regarding providers presenting problems with completing initial credentialing/re-credentialing
- Complete PsychConsult Network Credentialing Manager checklist for all practitioners assigned for review
6
Experience For Credentialing Analyst Resume
- Complete data entry at 95% accuracy
- Complete provider complaint documentation
- Initiate consultation with the Chief Medical Officer or designee when provider specific information warrants, to include but not limited to NPDB queries, Act 33 & 34, claims histories, licensure, references
- Represent Community Care in a professional, helpful, courteous manner
- Gather and manipulate data accurately and consistently
- Manage multiple task and be flexible to the daily needs of the organization
7
Experience For Senior Credentialing Analyst Resume
- Enters credentialing information data into CACTUS database in a timely and accurate fashion, interpreting or adapting data to conform to defined data field uses
- Review all submitted credential documents to assure completeness and compliance with Medical Staff Bylaws, the Joint Commission, NYS, and any other regulatory requirements and established procedures
- Identifies and flags adverse information from application materials for the purpose of conducting follow-up investigation in preparation for department and committee review
- Distributes Medical Staff appointment/reappointment documents to all clinical departments
- Maintains effective working relationships with new applicants, clinical departments and other departments to complete medical staff applications in a timely manner
- Maintains positive rapport with physicians and their staffs and responds efficiently to their requests
- Assures confidentiality of medical staff activities as they relate to the functions and responsibilities of the medical staff office
- Identifies problems, researches issues, and proposes solutions. Identifies routine requests and takes needed actions
8
Experience For Temporary Credentialing Analyst Resume
- Assists in the reappointment process in a comprehensive, well-organized manner
- Composes, edits and/or prepares any correspondence or special reports requested and coordinates any associated mailings
- Perform as the Program Manager and handles projects as assigned by manager
- Identify trends through analysis of program metrics
- Provide support and maintenance of tools used to automate and/or enhance onboarding and credentialing workflows, this includes but is not limited to Salesforce, Dataloader, DocuSign, Drawloop, and Taleo
- Develop and validate ad-hoc reports of practitioner data as requested by Vituity and contracted payers
- Evaluate new technology solutions and support set up process to further enhance onboarding and credentialing workflows
9
Experience For NV MCD Credentialing Analyst Resume
- Assist department managers with special technology projects by acting as a project liaison, evaluating requirements, providing support for requests, participation in system testing and data validation, and training of staff
- Maintain and run reports for workflow management of provider credentials data and various department workflows
- Prepare and audit monthly, quarterly, and annual provider data files needed for contracted payers, CVOs, and hospital medical staffs. Provide data and documentation for delegated credentialing audits, provider evaluations, and annual malpractice updates
- Support credentialing staff with dashboards, automations, letter/packet generation, and report writing, enhancing department quality and productivity with day-to day activities
- Work with department management, IT and Vituity PM Workgroups to document workflows, process improvement recommendations, and establish “best practices” to enhance credentials department productivity and quality
- Provide support with client onboarding and credentialing efforts including online application set-up, uploading and exporting data into the Salesforce credentialing database, NPDB continuous queries, and monthly sanction screenings
- Provide excellent customer service and credentials support to internal and external clients
- Utilizes web portals and electronic filing methods and maintains detailed data bases for Medicare and Medicaid credentialing and re-credentialing. Implements the initial start up of these methods
10
Experience For Onsite Credentialing Analyst Resume
- Analyzes data from multiple sources to facilitate and enhance the effective performance of the revenue cycle process
- Track all contract expirations for follow-up with Payor for renewal of agreement
- Work with State Medicaid enrollment and maintenance
- Communicate with Providers/ practice managers to initiate, update, and maintain credentialing services for MSO traditional clients, AMG employed practices or other Aultman facilities
- Verify Provider's education, hospital privileges, Board certification and other criteria as required
- Track contract application status
List of Typical Skills For a Credentialing Analyst Resume
1
Skills For Senior Credentialing Analyst Resume
- Credentialing experience in a hospital
- Understanding of revenue-sensitive matters and ability to prioritize resolution concerns
- Experience in staffing, talent acquisition, training and team building
- Two years of experience in administrative analysis, privileging/credentialing or operations
- Experience with WinZip and moving/saving electronic files
- Demonstrate knowledge of state, federal, and NCQA regulations concerning credentialing
2
Skills For Temporary Credentialing Analyst Resume
- Experience with 2-3 years directly related to hospital medical staff or managed care credentialing
- Support multiple team members and projects simultaneously and prioritize in a fast-paced environment
- Account management experience in sales-driven industry
- Strong character and integrity when handling sensitive data
- Experience in financial or credit reporting agency
- Demonstrated ability to collaborate with individuals and influence in various roles and levels
- Able to re-prioritize workload to meet deadlines with new and current projects
- Previous experience in a production environment (non-call center)
- Previous experience in a production or quota-driven environment (non-call center)
3
Skills For NV MCD Credentialing Analyst Resume
- Account management experience in a sales-driven industry
- Previous professional office or data entry experience required
- Mine data to complete evidence packages and assign daily activities to junior analysts and contractors
- Prioritize work assignments related to credentialing processes to ensure timely completion with satisfactory results
- Typing of at least 50 words per minute
- Maintaining adherence to standards and procedures
4
Skills For Onsite Credentialing Analyst Resume
- Maintain complete and accurate records regarding credentialing/re-credentialing for practitioners or facilities as assigned
- Provide back up for other Credentialing Analysts and to the Credentialing Team as assigned by the Credentialing Supervisor
- Coordinates meetings as requested, preparing/distributing agendas and meeting packets as required
- Manage a working queue and orders being processed so that productivity, accuracy and SLA goals are met
- Conducts credentialing based on the type of request or order, accurately following the complex documented policies and procedures
5
Skills For Onsite Credentialing Analyst Telecommute Resume
- Oversee junior analysts and contractors working on Credentialing Teams
- Maintain confidentiality concerning queries through all credentialing processes
- Assists in answering inquiries from other hospitals and healthcare organizations regarding medical staff status
- Verify accurate banking and billing information
- Maintains strict adherence to all Government and State rules regarding various Vetting Requirements
6
Skills For Credentialing Analyst Resume
- NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM), or Certified Provider Credentials Specialist (CPCS), or actively pursuing certification
- Utilizes multiple products and tools to verify and document that credentialing standards are met
- Communicates with applicants and customers daily to obtain needed documentation or information to complete the credentialing process and communicates the final decision, via phone and/or email
- Documents all interactions and documentation, recording details of findings and communications as well as actions taken while credentialing in the credentialing tool (MBS-ECT) for FTC, vendor provider and other audit purposes and data retention requirements
- Attends required training on policy and procedure updates as scheduled, usually quarterly, and a refresher training annually. Accurately applies the new information as trained when performing credentialing. 40 to 45 updates per year on average. 10%
- Experience in financial services or a credit reporting agency
- Experience in credentialing, provider relations, provider customer service or provider enrollment
7
Skills For Senior Credentialing Analyst Resume
- Experience with production environment and meeting metrics
- Fosters working relationships with leadership and other contract Points of Contact
- Assist the Credentialing Manager with State Medicaid enrollment and maintenance
- Engage Sales Representatives and Client Managers during escalations and remediations to creatively and appropriately resolve issues
- Identify issues requiring remediation
- Reasoned and creative ability to identify solutions, engage appropriate stakeholders and resolve outstanding matters efficiently
8
Skills For Temporary Credentialing Analyst Resume
- Perform daily investigative functions related to the verification of existing Equifax customers
- Coordinate site visit completion with Credentialing Analyst responsible for this task
- Enter provider data into PsychConsult Network Credentialing Manager and PSV Manager
- Identify problems/issues associated with the credentialing process
- Initiate and maintain fluid communication with individual providers being credentialed
- Track expired data for providers and follow-up appropriately including state licensure, professional references, NPDB, etc
- Utilize Equifax, NPDB, and the federal cumulative sanction software for credentialing
9
Skills For NV MCD Credentialing Analyst Resume
- Utilize the Provider at Risk list to assist to identify provider files requiring urgent attention
- Assists in maintaining up to date computer program for all currently approved appointees
- Maintains working knowledge of the medical staff bylaws/rules and regulations, delineation of privileges, and the policies and procedures of the hospital
- Assist with telephone coverage, appropriately responding to the variety of requests of the Medical Staff Services Department
- Engage Sales representatives and Client Managers during escalations and remediation to creatively and appropriately resolve issues
- Ability to identify issues requiring remediation
- Gather information needed by the Payors for contract submission, credentialing, maintenance and contract changes
10
Skills For Onsite Credentialing Analyst Resume
- Maintain and update credentialing spreadsheets and distribute to Managed Care team
- Consult with clients on best practice approach to credentialing for practice specific goals
- Enter and maintain Provider applications, contracts and updates into the system including CAQH
- Verify potential and existing Provider's licensure, liability insurance, CDS and DEA certification
- Perform ongoing research to correct data so it does not create duplicate provider, locations, payees and participants
- Update the system and the credentialing database to reflect approvals, denials and/or terminations
- Maintains strict adherence to all Government and State rules and regulations regarding confidentiality of Personally Identifiable Information
- Supports recurring internal and external audit of records
List of Typical Responsibilities For a Credentialing Analyst Resume
1
Responsibilities For Senior Credentialing Analyst Resume
- 1 – 2 years previous leadership experience
- Actively promote process improvement techniques in all work assignments and projects
- Detailed Review of Healthcare Providers’ submitted requirements including licensure, certifications, and other critical documents to determine document status
- Review healthcare providers’ submitted requirements including licensure, certifications, screens and other critical documents using AMIE system to determine HP document status versus requirements needed for specific assignment in order to pursue outstanding requirements
- Proficient computer skills (MS Office, including Word, Excel, and PowerPoint) including preparing statistical and analytical reports and PowerPoint presentations
- Work with diverse groups such as researchers, faculty, fellows, residents, students, nurses, and support staff
- Knowledge of common University-specific computer application programs and administrative systems
- Develop and maintain organized system for computerized records
- Military, law enforcement, compliance or operations background
2
Responsibilities For Temporary Credentialing Analyst Resume
- Familiarity with automation and IT project development
- Military, law enforcement or compliance background
- Review Healthcare Providers’ submitted requirements including licensure, certifications, screens and other critical documents using internal computer systems to determine if all necessary credentialing requirements have been met
- Communicate timely updates of HP document status with all internal stakeholders (e.g. Recruitment, Account Management, or branch office staff) via all necessary means of communication to facilitate a team approach to gathering all required documents
- Encourage timely and accurate document submission by establishing deadlines and monitoring document submission progress in order to deliver fully compliant packet to the client facility for an on-time start date
- Coordinate response to any and all assigned audits, and other requests by client facilities by completing the requests with accuracy and within the established/provided timelines
- Coordinate with 3rd party vendors to determine appropriate dates, times and locations for HP candidates to complete necessary compliance steps, including drug screens, background checks, immunizations, etc
3
Responsibilities For NV MCD Credentialing Analyst Resume
- Collaborate with Contracts Credentialing Analyst to review all new client contracts, or contract revisions, for Credentialing requirements
- Negotiate with client facility to reconsider unusual or uncustomary requirements by emphasizing the value and experience of the Credentialing Operations department with client facilities in order to minimize disruption of placements and optimize fill rate
- Previous experience in healthcare setting
- Experience in the credentialing process is REQUIRED
- Experience in healthcare industry
- Proven ability to communicate with internal and external customers and various third parties to attain desired results
- Knowledge of all relevant credentialing standards, including TJC, DoH, NCQA required
4
Responsibilities For Onsite Credentialing Analyst Resume
- Use Microsoft Office (Excel, Outlook, Word)
- Makes an accurate final, pass or fail decision
- Possess a high level of self-motivation and energy, and work with minimal supervision
- Proficiency in Adobe and/or Foxit PDF as well as the Microsoft Office Suite which includes Word, Excel, PowerPoint, Outlook
- Survey/Audit functions: Prepares for and staffs all Credentials Verification Organization (“CVO”) and Medical Staff Organization (“MSO”) credentialing audit functions
- MSO (HUP, PAH, PPMC and their provider-based sites)
5
Responsibilities For Onsite Credentialing Analyst Telecommute Resume
- Makes an accurate final, pass,or fail decision
- Attends required training on policy and procedure updates as scheduled, usually quarterly, and a refresher training annually. Accurately applies the new information as trained when performing credentialing
- 45 updates per year on average
- Ensure appropriate documents for requested access have been attached and are accurate/current i.e. business license, articles of incorporation, vendor references, etc
- Leadership/Collaborating for Results/FOUNDATION
- Physical Demands/ Working Conditions: Requires prolonged standing, some bending, stooping, sitting and stretching. Requires eye hand coordination and manual dexterity sufficient to operate a keyboard, photocopies, telephone, calculator and other equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports. Normal office environment
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