Credentialing Specialist Resume Sample
Brenden Kiehn
1137 Otha Roads,
Detroit,
MI
+1 (555) 343 7163
Work Experience
Credentialing Specialist
11/2016
-
PRESENT
Boston, MA
- Processes incoming provider applications and maintains existing contract and credentialing documents to ensure records and documents are complete, accurate and compliant with regulatory agency and corporate requirements
- Enters initial application and ongoing contracting and credentialing data status in system database to ensure up-to-date Provider Directory for all service locations
- Maintains current hardcopy and electronic vendor contract and credentialing files
- Responds to inquiries from internal and external callers requesting contracting and credentialing status and/or terms
- Recover missing data and replace unusable data on reports including editing report to ensure clarity of content, consistency of format and accuracy
- Supports the Provider Relations Director, Credentialing Management, Quality Management and Regulatory Compliance with requested data reporting
- Collect data and input to spreadsheets and databases
- Develop, maintain and provide various reports to present in the monthly Credential Committee
- Processes outgoing mail or other deliveries, as required
Senior Credentialing Specialist
09/2014
-
10/2016
New York, NY
- Willing to travel if necessary
- Receives and reviews submitted applications for completeness and compliance with instructions for preparation; ensures the timely completion of applications by communicating with and assisting the applicants in submitting all documentation necessary to process the application; identifies deficiencies and follows up to gather missing or incomplete data
- Uses discretion and independent judgment in determining the need for deviation from standard processes or more detailed investigation, including those involving fees, or that would cause processing delays in order to clarify, verify and/or confirm information contained in the credentialing application
- Perform primary and secondary source verifications of Practitioner’s credentials according to policy
- Performs the appropriate (applicable) credentialing processes in a timely and complete manner
- Uses, protects, and discloses DaVita Medical Group patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
- Responsible for processing provider applications and re-applications including initial mailing, review, and loading into the database tracking system ensuring compliance with required standards. Ensures the files for clinicians due for credentialing/re-credentialing are available for review by the Credentialing Committee each month and resolves outstanding issues prior to committee review
- Oversees primary source verification activities
- Ensures timely processing of all credentialing requests
Provider Enrollment Credentialing Specialist
03/2010
-
03/2014
Phoenix, AZ
- Responsible for facilitating monthly Credentialing Committee meetings
- Maintains provider enrollment files
- Directly responsible for payer delegated audits and reports audit findings to Executive Director and Credentialing Committee
- Compilation, coordination and management of clinician data disseminated to health plans and other payers
- Clerical support including data entry, filing, copying, scanning, faxing, etc. is required
- Contribute to a pleasant and comfortable environment; demonstrate respect and maintain patient’s dignity and confidentiality
- Perform outreach to providers and facilities via phone calls and fax/email correspondence
Education
Western New England University
2005 - 2010
Bachelor's Degree in Business
Professional Skills
- P rofessional demeanor, strong written and oral communication skills, strong computer skills, and the ability to learn Beacon’s internal systems
- Strong oral and written communication skills, research skills, ability to use word processing, spreadsheet and database software required
- Excellent communication and interpersonal skills; can effectively interface with internal and external customers, vendors and other credentialing staff
- Three (3) years administrative experience, that demonstrates attainment of the requisite job knowledge skills/abilities, preferably in a healthcare setting
- Excellent interpersonal skills and ability to effectively communicate both verbally and written with physicians and staff
- Strong organizational and excellent follow-up skills
- Strong customer service skills, excellent communication -- verbal and written
How to write Credentialing Specialist Resume
Credentialing Specialist role is responsible for microsoft, computer, word, organizational, database, customer, excel, interpersonal, credentialing, analytical.
To write great resume for credentialing specialist job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Credentialing Specialist Resume
The section contact information is important in your credentialing specialist 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 Specialist Resume
The section work experience is an essential part of your credentialing specialist 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 specialist 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 specialist position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Credentialing Specialist resume experience can include:
- Strong Excel skills, excellent written and verbal communication skills
- Demonstrate effective phone/verbal and written communication skills
- Has effective time management skills; able to organize and prioritize work based on compliance and/or business needs and drive it to completion
- Excellent writing, organizational and analytical skills
- Credentialing experience with hospital application experience or managed care experience
- Excellent PC skills with proficiency using Excel and other MS Office programs
Education on a Credentialing Specialist Resume
Make sure to make education a priority on your credentialing specialist resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your credentialing specialist 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 Specialist Resume
When listing skills on your credentialing specialist 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 specialist skills:
- Demonstrates excellent organizational skills, and the ability to prioritize and complete multiple tasks with competing deadlines
- Strong customer service skills, written and verbal communication skills, and attention to detail
- Problem-solve, multi-task, and utilize critical thinking skills effectively
- Communicates effectively (verbal and non-verbal skills) and works with others in a professional and competent manner
- Strong computer skills with intermediate knowledge of Word, Excel, credentialing software, and internet experience
- Strong customer service skill required; with the ability to work effectively with management, staff and physicians
List of Typical Experience For a Credentialing Specialist Resume
1
Experience For Senior Credentialing Specialist Resume
- Strong problem-solving skills in order to plan, organize, and coordinate physician credentialing process in a
- Demonstrates effective verbal and written communication that is clear, well-organized, and demonstrates an understanding of audience needs
- Strong analytical verbal and written communication skills
- Strong interpersonal organizational skills, teamwork and attention to detail
- Have strong computer, typing, and data entry skills: includes MS Word, Excel and database
- Proficiency in the use of Microsoft applications. Excellent verbal and written communication skills
2
Experience For Provider Enrollment Credentialing Specialist Resume
- Work independently and demonstrate advanced problem-solving skills
- Critical thinking, detail oriented and strong organizational skills required
- Clarification; respond well to questions; demonstrate group presentation skills; and participate in meetings
- Strong computer, data entry and clerical skills required
- A commitment to excellence, strong interpersonal, oral and written communication skills required
3
Experience For Credentialing Specialist Senior Resume
- Strong organization and communication skills and attention to details required
- Strong organization, communication and written skills, with attention to detail required
- Strong verbal communication skills and the ability to remain professional and courteous over the phone with customers at all times
- Credentialing & Privileging technical skills –credentialing process and primary source verification knowledge
- Work requires a high level of problem-solving skills necessary in order to plan, organize, and coordinate physician credentialing process
- Interfaces effectively with the Manager and Assistant Manager of Medical-Dental Staff Services all aspects of the assigned credentialing process
- Proficient in general computer skills including Microsoft Outlook, Excel and Word
- Demonstrates a high level skill using standard Microsoft Office desktop applications (Word, Excel, PowerPoint, Outlook)
4
Experience For Licensing & Credentialing Specialist Licensing & Credentialing Specialist Resume
- Three (3) years experience in credentialing or closely related healthcare administration experience required
- Three (3) years of prior multi-specialty physical medical group and credentialing experience with health plans
- Communicate effectively with all levels of administration, clinical divisions, practitioners, leadership and internal/external customers
- Have clear and concise phone and verbal communication skills
- Effectively manage customer service issues and maintain client base
- Works effectively with others to encourage teamwork and productivity
- Effectively manage customer service issues and maintain team quality expectations
- Superb organizational skills and meticulous attention to detail (required)
5
Experience For Temporary Dental Credentialing Specialist Resume
- Credentialing/privileging experience required
- Manage the pressures associated with setting priorities, handling a large workload, and managing workflow
- Five years of experience in a hospital setting and/or managed care setting
- Excellent understanding of the provider credentialing process
- Experience in credentialing, preferably in a managed care setting
6
Experience For Associate Credentialing Specialist Resume
- Two years experience in a medical credentialing environment (payer, IPA, medical group, or institutional privileging) required
- One year of experience working in a healthcare setting is required to work PRN
- A team player with multi-tasking capability and strong customer service orientation
- Demonstrate knowledge of credentialing regulatory and accreditation requirements (NCQA, CMS, Medicaid, etc..)
- Prioritizes work using the VISTA application, and maintain complete, accurate records of all activities
7
Experience For MSN Credentialing Specialist Resume
- Demonstrates emphasis on improving quality of staff, systems and environment
- Determine application form/attachments are complete prior to processing
- Maintain and update accurate information in the Echo database (includes education, training, experience, licensure)
- Six months of credentialing experience
- Previous experience in credentialing and medical staff coordination
- Credentialing or related experience
- Four years current experience in health care setting required
8
Experience For Credentialing Specialist Provider Enrollment Resume
- Multitask and prioritize all on going initiatives. Highly detail oriented approach to job function required
- Experience with credentialing software (Cactus)
- Previous experience working with Council for Affordable Quality Healthcare (CAQH) application highly desired
- Credentialing experience required
- Previous provider credentialing, healthcare or general office experience
- 3-year combination of education & experience in a medical setting
9
Experience For Provider Enrollment & Credentialing Specialist Resume
- Experience with Credentialing Accreditation by Joint Commission or National Committee for
- Maintain and monitor the database that includes pertinent education, training, experience, and licensure content
- Obtain appropriate credentials as well as updated copies prior to the expiration date of any license, certification, or other required document
- Duration: 3+ months open ended contract - strong potential for long-term employment and permanent conversion!
- Rate: Negotiable based on experience
- High level of customer service and/or phone experience
- Generally requires moderate administrative support experience
- ) experience in healthcare or managed care environment is required
10
Experience For Credentialing Specialist Unc Omss Resume
- Strong knowledge of managed care systems and contract related activities including; legal, regulatory and operational
- Extremely well organized and detail oriented with the ability to independently problem solve, and prioritize multiple tasks in a fast paced environment
- Previous experience in the health insurance/managed care industry required
- Previous office and clerical experience
- Experience with databases, data entry, Microsoft Word and Excel
- Prompt and effective communication with internal and external clients
- Balance workload amid interruption and change in priorities, potentially multiple times within the same work day (required)
- Experience in a hospital. provider or managed care setting
- Medical group experience or related area
List of Typical Skills For a Credentialing Specialist Resume
1
Skills For Senior Credentialing Specialist Resume
- Excellent computer data entry skills including entry level Excel knowledge,
- Excellent, organizational, independent judgment and critical-thinking skills required
- Demonstrated problem-solving and customer service skills
- Excellent administrative and interpersonal skills are required as well as the desire to be part of a team that functions at the highest level
- Excellent organization and public relations skills
- Self-starter, detail-oriented, excellent customer service and organization skills
- Work independently and demonstrate problem-solving skills. ·
2
Skills For Provider Enrollment Credentialing Specialist Resume
- Demonstrated communication skills, required
- Prior experience with updating credentialing or re-credentialing providers
- Advanced word processing skills REQUIRED, including advanced work in Adobe Acrobat Professional, Microsoft
- Experience setting up new group practices and experience in a hospital credentialing or provider enrollment department, is desirable
- Demonstrates a high level skill using standard Microsoft Office desktop applications (Word, EXCEL, PowerPoint, Outlooks)
- Office experience in a health care environment; or any combination of education and experience, which would provide an equivalent background
3
Skills For Credentialing Specialist Senior Resume
- Computer database skills and word-processing, required. Familiarity with Microsoft Office applications, desirable
- Proficiency skills in Microsoft applications Word, Excel, Power Point and Outlook
- Experience working with contracts or demonstrated knowledge of contract principles, and interpretation of contract language
- Interact effectively with a variety of people (physicians and medical staff offices)
- Have clear and concise phone and verbal communication skills ability to write legibly
- Understanding of the industry from a national perspective as well as a proven track record of success
- Credentialing and medical staff office experience
- Experience with credentialing / re-credentialing and/or privileging in the healthcare industry
4
Skills For Licensing & Credentialing Specialist Licensing & Credentialing Specialist Resume
- Experience with credentialing / re - credentialing and / or privileging in the health care industry
- Previous healthcare experience in a medical staff office setting, provider enrollment, or in credentialing services environment
- Previous experience as a Credentialing Specialist and/or Administrative Assistant within the Healthcare setting
- Excellent understanding of the credentialing process
- Credentialing experience, preferably in a managed care setting
- Experience working as a credentialing assistant or analyst (can be in a medical staff office, health plan or medical group)
5
Skills For Temporary Dental Credentialing Specialist Resume
- Previous Health Insurance and/or Doctor's Office Credentialing experience
- Demonstrated proficiency in credentialing software, e.g. Cactus, IntelliSoft, Vistar, Morrisey, etc
- Demonstrated proficiency in credentialing software, e.g. Cactus, IntelliSoft, Vistar, and Morrisey
- Healthcare credentialing experience
- Credentialing experience
6
Skills For Associate Credentialing Specialist Resume
- Excellent command of the English language, verbal and in writing
- Experience working in HR or similar department where information had to be obtained from various sources and verified in a timely manner
- Experience in Credentialing/MSO office
- Experience in proficiency in performing research
- At least two years’ experience in physician credentialing, human resources, medical administration or legal office required
- Physician Credentialing experience
7
Skills For MSN Credentialing Specialist Resume
- Two year experience with payer credentialing
- Experience working with Project Search interns required
- Experience with health care accreditation and regulatory standards including NCQA requirements
- Experience with Credentialing and or provider enrollment
- Able to adapt to and support staff during frequent changes in work load, priorities and work processes
- Experience with compliance and quality reporting
8
Skills For Credentialing Specialist Provider Enrollment Resume
- Three to five years of experience in hospital credentialing
- Previous credentialing or database entry experience
- Extensive experience with personal computers and multiple software programs required, with proficiency in word processing and use of the Internet
- Or more previous experience in credentialing or related health care field with knowledge of Joint Commission, DNV, and CMS Regulations
- Previous work experience in Healthcare facility
9
Skills For Provider Enrollment & Credentialing Specialist Resume
- Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up
- Experience in a hospital, provider, or managed care setting
- Experience in Credentialing in a managed care organization or hospital
- Experience in a customer service or healthcare related position
- Previous Medical Staff experience
- Administrative secretarial experience
- Strong attention to detail and follow through is required
- Experience in the healthcare industry
- Proven team player and customer service oriented
10
Skills For Credentialing Specialist Unc Omss Resume
- Supports enrollment and revalidation of Massachusetts Long Term Services and Supports (LTSS) providers
- Assist facility credentialing leads in the preparation of Disclosure of Information documents requiring corporate validation and signature
- Administrative experience and knowledge of NCQA and/or JCAHO standards
- Healthcare Administration experience
- Previous experience with Finance / Contract Administration
- Experience with NCQA credentialing standards highly desirable
List of Typical Responsibilities For a Credentialing Specialist Resume
1
Responsibilities For Senior Credentialing Specialist Resume
- Demonstrate professional verbal and written business communication skills
- Experience licensing and/or process management experience (within Behavioral Health/Long Term Care)
- Use active listening techniques effectively to determine the concerns, needs, and motivations of customers, co-workers, providers, etc
- Exhibits proficiency with data entry and computer skills for generation of daily office communication
- Communicates effectively with members of the Medical Staff, other medical professionals, hospital staff, legal counsel, and community contacts
2
Responsibilities For Provider Enrollment Credentialing Specialist Resume
- Establishes and ensures effective monitoring process of new physicians as prescribed by the departmental bylaws
- Credentialing experience required
- Or more previous experience in credentialing or related health care field with knowledge of Joint Commission, DNV, and CMS Regulations required
- Two (2) years practitioner credentialing experience, or
- Credentialing experience with knowledge of various insurance payers
- Three (3) years of managed care provider credentialing experience required
- Experience in a hospital provider or managed care setting Required
- Well experienced with CAQH, credentialing database(s),etc
- Self motivated & ability to adapt to changing priorities
3
Responsibilities For Credentialing Specialist Senior Resume
- Experience in the area of Provider Credentialing
- Previous experience working with CAQH application highly desired
- Healthcare credentialing experience is required
- Demonstrates high proficiency utilizing Microsoft Office Suite (Word, Excel, PowerPoint, OneNote)
- Demonstrates professionalism when interacting with coworkers and members of the Medical Staff
- Initiates extensive investigation into the applicants background, education and experience through the use
- Work well under difficult circumstances and tight time lines. Know how to prioritize throughout the day as work flow changes
- Three years of progressively responsible administrative support experience required
4
Responsibilities For Licensing & Credentialing Specialist Licensing & Credentialing Specialist Resume
- Healthcare related experience required
- Collecting credentialing documentation and accurately building provider credentialing files according to contractual and NCQA standards
- Completing and submitting group applications for any new locations or re-credentialing applications
- Working knowledge of MD Staff Credentialing Software is essential
- Completing any re-credentialing application on the providers
- Understanding of credentialing Joint Commission, NCQA, and URAC accreditation standards
- Facilitating all aspects of the initial application, and monitor privileging for medical staff and allied health practitioners
- Ensuring compliance with the Medical Staff Bylaws and Joint Commission standards in regards to credentialing
- Working knowledge of Medicare and Medicaid regulations and NCQA accreditation guidelines associated with health plan credentialing
5
Responsibilities For Temporary Dental Credentialing Specialist Resume
- Understanding of JCAHO accreditation standards as they apply to Credentialing
- Submitting notification letters to plans for new locations or any updates to facilities
- Processing New Physician and Allied Health professional applications per Company and regulatory standards
- Coding certification within one year of employment
- Assisting with the reappointment process on an as needed basis
- Typing speed with accuracy
- Working knowledge and familiarity with common “deal terms” used in M&A transactions, preferably in a healthcare environment (required)
- Understanding of Joint Commission certification
6
Responsibilities For Associate Credentialing Specialist Resume
- Contributing to team performance through collaboration on tasks, participation in H3W and other staff meetings, huddles, etc. Informs leadership of work
- Willing to obtain CPCS from National Association of Medical Staff Services (NAMSS) first year of NAMSS eligibility or within 3 years of employment
- Responsible for preparing and maintaining the credentialing reporting document for regional credentialing
- Determine credentialing status by screening and assessing all credentialing materials. Research, analyze and process routine credentialing cases
- Tracks the recredentialing cycle of provider’s credentialing. Prepares files for monthly Credentialing Committee
7
Responsibilities For MSN Credentialing Specialist Resume
- Assist with identity research and entry/scanning of data into credentialing database for referring practitioners
- Maintain filing and scanning of all necessary credentialing documentation
- Monitors the aging of pending applications to ensure timely follow-up is conducted to secure missing information
- Complete all internal auditing of staff completed credentialing and recredentialing files within the required turnaround time
- Send credentialing files to the CVO and track progress using excel spread sheets and Credentialing database notes
8
Responsibilities For Credentialing Specialist Provider Enrollment Resume
- Follow-up and tracking of providers and facilities to obtain missing credentialing materials to ensure they get credentialed
- Assist with follow-up and tracking of provider re-credentialing applications to obtain missing materials to ensure they get credentialed
- Assists the Credentialing Manager in monitoring credentialing files for accurateness
- Knowledge of physician payer credentialing, physician and allied provider privileging, and physician/provider and site regulatory licensing required
- Knowledge of physician payer credentialing, physician and allied provider privileging, and physician/provider and site regulatory licensing
- Document all tasks, phone calls, emails and other forms of communication during the credentialing and re-credentialing process in the database
- Runs daily batch matching Inventories to FACTS in order to update missing document statuses
- Responds to urgent requests from Credentialing team to ensure timely Credentialing is completed
- Assist with conducting inventory all PC equipment and tracking hardware for the SSC
9
Responsibilities For Provider Enrollment & Credentialing Specialist Resume
- Responsible for resolving any credentialing log issues
- Maintains Vistar system (credentialing database) including the mappings of specific payer applications
- Maintains confidentiality of credentialing information regarding applicants, Medical Staff and Allied Health members, and peer reviewers at all times
- Assists in Credentialing projects and planning
- Maintains current copies of accreditation standards and strives to learn the credentialing processes and other Credentialing responsibilities
- Organize and maintain provider credentialing and re-credentialing files, as well as inactive provider files
10
Responsibilities For Credentialing Specialist Unc Omss Resume
- Review credentialing information and processes on an on-going basis to identify possible process improvements
- Completes the review of all credentialing and recredentialing applications submitted to Health Plan
- Notify facility IDT and continuum partners regarding outcome metrics falling below the quality performance threshold
- Assist with coverage during staffing shortages and leaves of absence
- Serves as the primary point of contact for all incoming mail to the department and enters information into appropriate system for tracking purposes
- Receives and processes incoming applications and supporting credentials from providers
- Accurately enters required hospital credentialing data into the Visual Cactus credentialing database, and payer enrollment data into CAQH
- Manage inbound and outbound calls relating to escalated claims issues, credentialing issues and or process
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