Credentialing Coordinator Resume Sample
Darion Ratke
696 Clare Extension,
Phoenix,
AZ
+1 (555) 280 7091
Work Experience
Senior Credentialing Coordinator
04/2018
-
PRESENT
Dallas, TX
- Performs monthly queries, updates expired licenses, DEA’s and malpractice certifications for providers and office locations
- Keep up to date on all changes in hospital policies and department regulations
- Assist with the training of other Credentials Coordinators
- Attend local, state, and/or national meetings/conferences relating to practitioner credentials and
- Responsible for committee finalization, including but not limited to: mailing and filing of approval letters/sheets, organizing minutes for the minute’s binder, and entering approval dates in the credentialing database
- Responsible for credentialing and re-credentialing internal providers with hospitals, IPA’s, medical groups, and health plans on an ongoing basis
- Facility entries in Medicare’s PECOS database
Credentialing Coordinator
12/2011
-
02/2018
Boston, MA
- Strong computer knowledge and technical skills; specifically with Excel
- Organize and prioritize work and manage multiple priorities
- Assists with the entire credentialing process, meeting deadlines on the completion of a physician’s application to the medical staff, securing of temporary or emergency privileges for physicians as necessary in compliance with Medical Staff Bylaws and all related policies, the Joint Commission credentialing standards and appropriate licensing board requirements
- Displays knowledge of when to refer problem applications or situations to the Director of the department
- After appointment/reappointment decision is reached, updates existing files to reflect new status and approval at Credentials/MEC/Board of Trustee meetings. In accordance with office procedure, updates electronic database and prepares appointment/reappointment/resignation correspondence
- Maintains current reference/resources of all required information. Is knowledgeable as to where to access information if not readily available
- Maintains current knowledge of the Joint Commission, Medical Staff Standards, state and federal requirements, hospital and Medical Staff Bylaws, Rules and Regulations, Policies and Procedures. Participates as needed in the Joint Commission preparedness
Credentialing Coordinator GI Associates
12/2004
-
06/2011
Boston, MA
- Ensures that all expiries are obtained and reviewed on a monthly basis, updating the system to reflect changes, verifying as required
- Maintains current knowledge of credentialing software used by the department
- Provide office coverage as necessary to ensure appropriate level of departmental operation
- Makes recommendations for change in departmental procedures or computer systems to accomplish goals as necessary
- Participates in problem solving by taking the initiative in identifying problems and seek necessary resources or information to assist in solving any problems that arise in the credentialing process
- Provides customer services as needed
- Communicates appropriately for every interaction with every person, every encounter, every day
- Process and maintain initial credentialing and re-credentialing files for physicians, mid-level practitioners, and other ancillary providers
- Responsible for tracking practitioner applications, verifications and other pertinent information regarding credentialing files for correctness and completeness
Education
Argosy University - Tampa Campus
1999 - 2003
School's Degree in Business
Professional Skills
- Excellent computer skills, In-depth knowledge of credentialing process, self-starter, detail-oriented, excellent customer service skills
- Demonstrates good oral and written communication skills with strong interpersonal skills
- Demonstrates good oral and written communication skills with strong interpersonal skills
- Proven and excellent customer relations skills, and the ability to communicate effectively with physicians and executives
- System Skills: Advanced computer skills. Ability to use all applicable applications at highest competency level
- Using strong research skills to gather pertinent information
- Demonstrated administrative skills (typing, filing, telephone management, data entry) and knowledge of basic office practices
How to write Credentialing Coordinator Resume
Credentialing Coordinator role is responsible for computer, organizational, interpersonal, software, advanced, medical, basic, database, microsoft, organization.
To write great resume for credentialing coordinator job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Credentialing Coordinator Resume
The section contact information is important in your credentialing coordinator 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 Coordinator Resume
The section work experience is an essential part of your credentialing coordinator 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 coordinator 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 coordinator position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Credentialing Coordinator resume experience can include:
- Good command of English language, including medical and scientific terminology, and strong writing skills
- Strong organizational skills with ability to prioritize projects, work relatively independently, manage multiple tasks, and meet deadlines
- Strong communication skills; ability to be persistent, and have good follow-through
- Prior provider credentialing experience based on a combination of education and experience
- Successful organizational skills, including prioritization and time management
- Effective interpersonal and communication skills and the ability to interface with personnel at all levels
Education on a Credentialing Coordinator Resume
Make sure to make education a priority on your credentialing coordinator resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your credentialing coordinator 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 Coordinator Resume
When listing skills on your credentialing coordinator 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 coordinator skills:
- Demonstrates ability to maintain excellent customer service skills and customer relations under stressful conditions
- Solid Database management skills including querying, reporting, and document generation
- Excellent organizational skills, including ability to work on multiple ongoing projects and consistently meet deadlines
- Demonstrated skills in customer service, telephone, typing
- Demonstrated skills in problem solving and analysis and resolution
- Good computer skills and able to work with MS Office
List of Typical Experience For a Credentialing Coordinator Resume
1
Experience For Senior Credentialing Coordinator Resume
- Strong analytical skills to assess compliance, record, analyze and interpret data into meaningful reports
- Strong interpersonal skills with the ability to interact with all levels of faculty and staff
- Excellent verbal and written communication skills with individuals at all levels of the organization
- Excellent oral and written communication as well as interpersonal skills with a focus on internal and external customer satisfaction
- Excellent interpersonal/communications skills; Ability to interact with individuals at all levels of the organization
2
Experience For Credentialing Coordinator, Direct Bill Resume
- Excellent organization, multi-tasking, and time-management skills with high-level attention to detail
- Excellent written, verbal, & interpersonal communications skills
- Prior experience with verification letters- sending and processing requests
- Communication (written, verbal and listening) and problem solving skills
- Validates completeness of provider applications prior to processing
3
Experience For Credentialing Coordinator GI Associates Resume
- Communicate effectively with a professional attitude
- Use Excel effectively to create reports, combine data from multiple sources, and use judgement to analyze data for quality and potential audit risks
- Basic computer skills and ability to use company database
- Word, Excel, Databases, and Power Point skills
- Communicate effectively, both orally and in writing, with multiple levels within the organization
- Experience in a credentialing related position or similar experience
- Work independently, effectively and well in both individual and team environments
- Computer skills required: databases, Microsoft Word, and Excel
4
Experience For Credentialing Coordinator, Senior Resume
- Customer service or administrative experience, or equivalent combination of education and experience
- Multi-task and prioritize workload, manage multiple priorities, and pay meticulous attention to detail
- One year experience in healthcare credentialing or healthcare clerical role with a working knowledge of the credentialing function
- Validate full health insurance premium payment is received during onboarding
- Experience with following processes and continually improving processes and workflow to gain efficiencies of performance
- Demonstrate and maintain credentialing knowledge. Keep abreast of new and changing regulations and standards
- Responsible for developing and updating Contract Summary Sheets with physician effective dates
- Maintains excellent relationships with healthcare facilities nationwide to understand their unique credentialing processes
5
Experience For Credentialing Coordinator Associate Resume
- Related experience with physician and associate practitioner credentialing required
- Demonstrate the ability to work as a cooperative team member within the Licensing Section
- Experience working in patient care environments
- Previous experience working with Pathology or similar healthcare or research environment, helpful
- Medical staff/credentialing experience
6
Experience For GME Licensing & Credentialing Coordinator Resume
- Prioritize work activities and track progress on all files
- Performs research to validate practitioner qualifications
- Participates with audits to validate readiness of files for scheduled/non-scheduled payer audits
- Previous experience in Hospital Credentialing required
- PSV includes, but is not limited to compliance with all relevant standards to confirm an applicant’s education, experience, and qualifications
- Able to multi-task while being proactive in a fast-paced environment with frequently changing priorities and workloads
- Recognizes, investigates, and validates discrepancies and adverse information obtained from the application, primary source verifications, or other sources
7
Experience For Department of Medicine Credentialing Coordinator Resume
- Previous customer service and/or phone experience
- Experience using Microsoft Office programs, especially Excel, Word, PowerPoint, and Access required
- Demonstrated ability to maintain detailed and confidential information
- Retrieving, delivering and filing/storing records in accordance with daily scheduled, emergency and special project needs
- Maintaining medical staff credentials and licenses in accordance with the local file management practices and the electronic or manual record filing system
8
Experience For Credentialing Coordinator Lead Resume
- Reviewing records for completeness and accuracy of required information content and taking appropriate actions to assure record integrity
- Monitoring and ensuring credentials documents are maintained and current
- Ongoing monitoring of credentialed network for accuracy or any change in status to include regular internal practitioner record audits
- Verifying supporting documentations
- Completing insurance applications and contracts to support over 1200 dentists
- Verifying professional licensures to meet our policy and procedures
9
Experience For Physician Credentialing Coordinator Resume
- Working as a member of a dynamic team
- Ongoing Medical staff/allied health professional database maintenance of MSOW and MS4
- Passing the WI Caregiver Background Check and/or IL Health Care Workers Background Check
- Working in NPDB, AMA, SAM and OIG
- Auditing initial applicant file
- Processing reappointment applications
10
Experience For Msla-credentialing Coordinator Specialist Resume
- Assisting with client payer audits
- Working knowledge of Microsoft Office, Skype and other software used in daily work
- Performs various administrative functions including typing correspondence, copying, faxing, filing, Fed Ex, operating basic office equipment
- Responsible for processing, evaluating, alphabetizing and filing credentialing materials for applicants
- Assure all practitioner data is accurate and up-to-date in the CACTUS credentialing software application, including generating and monitoring reports
- Responsible for updating the Recredentialing portion of the database and auditing plans quarterly to ensure all recredentialing efforts are current
- Assists in coordinating and scheduling Credentialing Committee meetings; creates and maintains meeting minutes
- Tracks credentialing status; presenting verified, completed credentialing packets for submission to applicable agencies for approval
List of Typical Skills For a Credentialing Coordinator Resume
1
Skills For Senior Credentialing Coordinator Resume
- Strong interpersonal skills with the ability to develop strong working relationships
- Two to three (2-3) years of general office experience with demonstrated verbal and communication skills
- Good letter writing and written communication skills
- Excellent professional communication, presentation and analytical skills
- Excellent organizational skills and ability to manage multiple tasks/projects simultaneously
- Excellent verbal and written communication skills, ability to interact with all levels of personnel
- Able to show great attention to detail, excellent organizational skills and maintain strict confidentiality
- Handle assignments independently with demonstrated analytical and interpersonal skills
2
Skills For Credentialing Coordinator, Direct Bill Resume
- Strong analytical skills are required
- Excellent computer skills (preferably Microsoft Office - Word, Excel and PowerPoint)
- Outstanding computer and technical skills
- Working experience utilizing strong verbal and written communications
- Administrative professional with intermediate to advanced office skills including typing, editing/proofreading, filing
- Health plan experience, related experience and/or training with an understanding of NCQA Credentialing requirements
3
Skills For Credentialing Coordinator GI Associates Resume
- Experience in Credentialing Providers, working in Provider Relations, or Quality Management Experience in a production or deadline driven environment
- Prior hospital credentialing experience
- Communicate accurately and effectively and build positive working relationships throughout all levels of the organization
- An individual with the ability to communicate appropriately and effectively with practitioners and providers; including sensitive and confidential information
- Demonstrated experience functioning in a team environment with key timeliness and productivity measures
- Experience working in support of medical professionals in a clinical and/or academic environment, strongly desired
- Exceptional communication and customer relation skills
4
Skills For Credentialing Coordinator, Senior Resume
- Experience in effective professional business communication, both verbally and in writing, with physicians, nurses, and office staff
- Interpersonal skills that convey a positive and supportive attitude with multiple hospital, office and medical staff departments
- Experience in processes with progressive responsible experiences to include computerized functions
- Prior HR or Legal Assistant experience helpful
- Able to deal effectively and professionally under pressure
- Basic computer skills and proficiency in MS Word, Excel, PowerPoint and Outlook required
- Assertive and confident communication skills
5
Skills For Credentialing Coordinator Associate Resume
- High level of attention to detail with exceptional organizational skills
- Updating Managed Care Monthly (MCM) Updates with provider’s effective dates
- Working experience to perform constant repetitive tasks
- Working experience with the Commercial Small Group/Individual Enrollment application intake approval process
- Experience with Microsoft Excel (editing, cutting, pasting, filtering, creating lists, and simple formulas)
- Experience with Microsoft Excel (editing, cutting, pasting, filtering, creating lists, simple formulas)
- Experience with Microsoft Excel and Microsoft Word (creating spreadsheets, modifying and filtering results, and performing mail merges into letters)
- Experience with processing initial and re-credentialing applications in a hospital setting
6
Skills For GME Licensing & Credentialing Coordinator Resume
- Previous experience in medical staff credentialing or related area such as 2 years in Managed Care credentialing or in an academic medical center setting
- Experience in Credentialing Providers, working in Provider Relations, Medical Billing, or Quality Management
- Experience with Microsoft Word (creating, editing, and saving documents)
- One year experience in healthcare credentialing or healthcare clerical role with a working knowledge of the credentialing function
- Knowledge of and experience dealing with implementing NCQA or JCAHO credentialing standards
7
Skills For Department of Medicine Credentialing Coordinator Resume
- At least one year of experience in managed care organization credentialing or hospital credentialing/privileging
- Skill and proficiency in performing administrative responsibilities commensurate with requisite Education/Training
- Experience with Microsoft Word (creating and saving document)
- Prioritize and meet deadlines on an ongoing basis to ensure timely completion according to process requirements
- Provider credentialing/recredentialing experience in a health plan
- Experience working with Credentialing Providers, Provider Relations, or Quality Management
8
Skills For Credentialing Coordinator Lead Resume
- Two (2) or more years of relevant credentialing experience in a hospital setting, health plan, or certified verification organization (CVO)
- Experience directly related to Hospital Credentialing
- Previous experience with provider credentialing processes and procedures
- Previous experience with Provider Credentialing processes and procedures
- Experience working in a team-oriented, collaborative and matrix environment
- Recent credentialing/medical services or closely related experience specific to the state of Illinois
- Previous credentialing experience
9
Skills For Physician Credentialing Coordinator Resume
- Experience in a healthcare or other related environment requiring administrative and detail-oriented responsibilities
- Experience in credentialing required
- Previous experience in a corporate or office setting
- 1 year of experience in managed care and/or credentialing
- Experience with State and Regulatory agency requirements as it relates to healthcare credentialing guidelines
- Strong ability with Microsoft Office, including Outlook, Word and Excel
- Strong knowledge of healthcare billing operations
- Experience utilizing computer databases
- Experience in medical group credentialing/provider enrollment desired
10
Skills For Msla-credentialing Coordinator Specialist Resume
- Credentialing Experience in an Acute Care Hospital
- Credentialing experience in a hospital medical staff office (MSO) or Physician Practice
- Microsoft Office software (Word, Access, Excel, PowerPoint), and preferably experience with Credentialing systems
- Experience in credentialing physician applications
- Prioritize work using the VISTA application, and maintain complete, accurate records of all activities
- Credentialing experience
List of Typical Responsibilities For a Credentialing Coordinator Resume
1
Responsibilities For Senior Credentialing Coordinator Resume
- Experience in credentialing providers, working in provider relations, medical billing, quality management, or transportation
- Two (2+) or more years of relevant credentialing experience in a hospital setting, health plan, or certified verification organization (CVO)
- Solid knowledge of credentialing processes, requirements, and NCQA guidelines
- Review files processed by Credentialing Coordinator(s) prior to committee review
- Two to five years’ credentialing experience in acute care, CVO (centralized verification organization), and/or managed care environment
2
Responsibilities For Credentialing Coordinator, Direct Bill Resume
- One to two years’ experience in medical staff database management (Access or credentialing software)
- Experience using a computer and MS Office such as Word, Excel, PowerPoint and Outlook
- Complete and review all applications to ensure accuracy prior to submission
- Provides excellent customer service in accordance with EmCare’s customer service standards to all internal and external parties
- Respond to internal and external eligibility inquiries on a priority basis
- Validate Small Group shell set up guidelines and requirement to execute per application classification
- Six years of related experience. <
- Experience with credentialing accreditation by The Joint Commission or NCQA
- Balance priorities and daily responsibilities and notify supervisor of any barriers
3
Responsibilities For Credentialing Coordinator GI Associates Resume
- Strong attention to detail and quality results
- Being responsive to verification requests, filing, answering phones, and assisting others as needed
- Maintaining monthly auditing of Licensure and Liability for Provider Network
- Communicating regularly with the providers to make sure they are within compliance
- Proctoring as assigned by Department Chair
- Reviews Credentialing and Re-Credentialing files to determine risk and documents summaries of all risk files requiring National Credentialing Committee Review
4
Responsibilities For Credentialing Coordinator, Senior Resume
- Responsible for orientation, training and development of credentialing staff that is responsible for credentialing and privileging activities
- Provides analytical support including data entry, analysis and graphical representation of data using Microsoft Excel and editing and writing reports
- Proficiently use MS Office and the credentialing software to accurately enter and maintain physician information and track incoming and outgoing requests
- Coordinate credentialing and re-credentialing processes, maintaining task grids and tickler systems to assure follow up and completion
- Responsible for handling funds to properly process the accounting records as assigned by the director of licensing and instructed by the controller
- Consistent monitoring of the processing of credential and re-credentialing applications at BWH, BWF and DFCI for all clinicians
5
Responsibilities For Credentialing Coordinator Associate Resume
- Document all tasks, phone calls, emails and other forms of communication during the credentialing/recredentialing process
- Presents on credentialing topics during monthly training and educational sessions
- Knowledgeable of regulatory, accreditation and other external customer requirements regarding credentialing including, but not limited to, NCQA, JC, and CMS
- Reports to the Credentialing Services Supervisor and performs all day-to-day activities related to the credentialing and recredentialing of facility providers
- Follows up on all discrepancies and/or issuesfound during the credentialing process
- Knowledge and understanding of credentialing
- Supports the Credentialing Specialists’ as it relates to their day-to-day operating processes
- Assist in updating the database to reflect Credentialing Committee decisions
- Responsible for entering billing information into Centricity EDI
6
Responsibilities For GME Licensing & Credentialing Coordinator Resume
- Develops reports and queries utilized by the Officers of the Medical Staff and the Hospital Governing Board to make decisions regarding (re) appointment
- Responsible for accurate input and modifications to the credentialing database and for performing audits to assure accuracy
- Reviews all newly identified sanctions and documents summaries of all sanctions requiring National Credentialing Committee review
- Responsible for processing and maintaining applications and credentials submitted by applicants for various types of licenses
- Maintain existing database, automate the credentialing and medical staff process for the department
7
Responsibilities For Department of Medicine Credentialing Coordinator Resume
- Coordinate mailing of credentialing letters
- Responsible for creating Physician Reference Guides (PRG) in the department’s Access Credentialing Database for new physicians
- Process all initial credentialing and re-credentialing of approximately 250 HMU clinicians
- Review credentialing application for completeness, log and request missing documentation
- Participate in the preparation of files for credentialing committee meetings, delegated credentialing audits and desktop audits
- Work with supervisor in identifying back-up coverage and assigning files when out of the office
- Assist in preparation of files for Credentialing Committee meetings, delegated credentialing audits and desktop reviews
- Obtain provider performance reports for the credentialing and re-credentialing process
- Conducts audits and works with Credentialing Manager and Director on a variety of credentialing issues to facilitate quality assurance efforts
8
Responsibilities For Credentialing Coordinator Lead Resume
- Leads improvement processes by identifying trends, recurring issues and communication problems
- Ensure timely completion of credentialing and re-credentialing of providers
- Researches, collects and reports on local regulatory changes impacting credentialing requirements
- Works closely with start-up teams to recruit, educate and training new and/or expanding NEMT provider networks
- Remain current in regulatory matters surrounding credentialing particularly with regard to Medicare and other public payer programs
- Responsible for ensuring that Licensing Board Disciplinary Reports are ran and reviewed within a 30 day cycle as required
- Work with Manager in identifying back-up coverage and assigning files when out of the office
- Participates in ongoing assessment of governing documents (bylaws, rules and regulations), standards and policies to ensure continuous compliance
9
Responsibilities For Physician Credentialing Coordinator Resume
- Processes applications following policies, NCQA, and JC standards within the established amount of time and assuring quality goals are met
- Functions as a resource to customers and entities on credentialing and privileging issues
- Keep all credentialing files and credentialing database current and complete
- Expirables, on-going monitoring
- Assists Credentialing Specialist with the initial and re-appointment credentialing process
- Responsible for up-to-date electronic data entry and hard copy filing of credentialing documents
10
Responsibilities For Msla-credentialing Coordinator Specialist Resume
- Maintains credentialing files (electronic & paper) for each applicant and participating provider
- Provides administrative support for Credentialing Specialist & the Credentialing Committee
- Updates roster of the medical staff which is prepared following each Board meeting and sent to Department Chairs and Department secretaries
- Conducts primary source verification for all credentialing and recredentialing applications
- Process and complete initial credentialing applications for new providers (physicians and allied health professionals) ensuring the application is complete and that required documents from the applicant have been submittedwith the application
- Personally completes, or assigns to clericalstaff, all required primarysource verifications and ensures timeframes are within specified PAMF standards(in accordance with NCQA stds)
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