Credentialing Specialist Resume Samples
Credentialing Specialists are responsible for verifying the professional licenses and certifications of medical staff. Their duty is making sure that federal and state standards are met and they may also assist auditors and help keeping a facility's accreditation. The strongest example resumes for Credentialing Specialists emphasize health information expertise, organization, attention to details, teamwork and communication skills. Report writing skills are a must. Most sample resumes for Credentialing Specialists highlight an Associate's Degree in health information management.
For more information on what it takes to be a Credentialing Specialist, check out our complete Credentialing Specialist Job Description.
Senior Credentialing Specialist
Processed provider credentialing information, including verification of data in accordance with policies and procedures, to support network development and credentialing processes.
- Assisted in preparing and coordinating provider information to / from managed care quality committees and other internal departments and / or external entities.
- Exceeded production goals by 99% while maintaining quality.
- Maintained credentialing database while tracking all direct provider contract data.
- Performed primary and secondary source verifications of credentials according to departmental policy.
- Maintained all medical license, Drug Administration and malpractice insurance for physicians and mid-level providers.
- Ensured compliance with national standards of quality organizations.
Credentialing Specialist I
Supervised Payor Audits
- Audited, data entered, and preformed primary source verifications in accordance with various regulatory agencies for credentialing, recredentialing, and delegated accounts.
- Resolved practitioner concerns in a timely manner.
- Analyzed reports to ensure processing compliance.
- Produced canned reports and maintained Visual Cactus Database
Exceeded performance standards
- Promoted special projects to enhance operations
- Efficiently credentialed all initial applicants in a timely fashion
- Supported enterprise decision-making with subject matter expertise
- Provided excellent customer service to practitioners, managers and teams as evidenced by satisfaction surveys
Lead Credentialing Specialist
Assessed applicant skills and abilities to confirm suitability and make appropriate position matches for government contracts. Coordinated with administrative points of contact in each staff element to ensure pool of applicants matched open needs.
- Provided assistance and guidance to employees with resume preparation, health record requirements, and completion of the personal provider information sheet (PPIS), and SF85P forms.
- Provided written and verbal instructions throughout each step of the credentialing process.
- Performed primary source verification of provider credentials, education, and employment history.
- Conducted electronic queries using databases for verification and sanction information for the credential file and contract application. Researched salaries for salary survey and comparison.
Credentialing Specialist, Office of Medical Staff Affairs
Managed credentialing process for initial appointments and reappointments of medical staff working closely with department chairmen, faculty, and hospital administrators
- Increased productivity and improved efficiency by systematizing and creating a performance improvement plan for the re-credentialing process
- Lead the transition from paper to electronic application submission (in process)
- Verified the professional licensing, training, and certifications of professional medical staff to ensure healthcare professionals comply with all established regulations and guidelines
- Assisted in interpretation and enforcement of Medical Staff Bylaws and Joint Commission standards and provide guidance to Medical and Dental Staff when necessary
- Maintained and updated all practitioner databases
- Reviewed credentials files and ran reports for potential red flags
- Assisted in areas of budgeting, performance improvement, and compliance as needed
- Attended monthly Medical Executive Committee, Credentials Committee, and Quarterly Medical Staff Meetings with hospital administrators as required
I began this position without any knowledge after only being there for 6 months the other Credentialing Specialist gave her 2 weeks notice. At that point of time I took over and continue to be the only credentialing specialist for 9 different hospitals.
- I don't hold any certificates at this time, partly because I needed to have at least 2 years of experience in the field and once I had the 2 years of working knowledge I was so busy and continue to busy but I am willing to get certified.
- I am a member of NAMSS.
- At this time I currently do all aspects of credentialing for over 500 providers at 9 different hospitals.
- I prepare the Credentialing Agenda, Credentialing Report and provide the minutes for the Credentialing monthly meeting.
- I provide the Orientations for all new providers.
- Credentialing Software - Midas/Series
Enhance and conduct onboarding process for all new hires (Physicians, Nurse Practitioners, Physician Assistants and Scribes)
- Coordinate, manage, and maintain Scribe onboarding for the team
- Develop process improvement initiatives to improve operational efficiency and reduce onboarding turn over time
- Collaborate with new hospital clients and establish processes to facilitate onboarding for new hires by a strict deadline
- Generate and deliver onboarding process reports for hospital management by providing status updates on new hires
- Build and manage relationships with hospital clients, recruiting and physician leadership
- Developed and implemented onboarding workflows, hospital requirements paperwork, and best practices for onboarding team
- Received three "MedAmerica: All Star" awards for demonstrating accountability, providing exceptional service, teamwork and camaraderie
Coordinate the credentialing process for a staff of 30 pathologists. Monitor and renew medical licenses and malpractice insurance.
- Execute applications and track the process for new State medical licenses for providers.
- Collaborate with insurance companies and process enrollments into Medicare and MassHealth.
- Maintains appropriate CME requirements for each State license for individual physicians.
- Resolve contracting issues with credentialing and continually initiate system and process improvements.
- Verify State licenses, Board Certificates using the National Practitioner Data Bank Report, online verification of medical licenses, Veridoc, Federation of State Medical Boards, Uniform License Application.
Meet with Providers to discuss contracting and insurance requirements for participation with each insurance company.
- Prepare and submit all appropriate applications and required supporting documentation.
- Follow-up with insurance companies to insure timely processing of applications and contracts.
- Educate providers on credentialing and contracting guidelines and requirements
- Facilitate monthly and or weekly meetings with insurance provider representatives to insure escalated issues are handled and resolved in a timely manner.
- Run daily production and task inventory, discuss with management appropriate course of action to maintain work load and productivity requirements.
Promoted to Credentialing Analyst for largest client as a specialist.
- Worked within a specialized team to maintain provider profiles for over a thousand healthcare providers, as well as new enrollments for healthcare providers new to the system.
- Created a system to maximize workflow and communication within the team to increase efficiency, output, and quality of service by establishing new guidelines and procedures.
- Assisted in managing accounts by maintaining client relations and performing routine checks and audits for oversight.
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100 Main Street, Cityplace, CA, 91019 | (H) (555) 322-7337 |firstname.lastname@example.org
Tier I Certified Professional, highly-motivated bilingual placement specialist with more than 15 years of experience in establish public relations and employment network. Flexible and versatile team player who maintains a sense of humor under pressure. Highly personable, with extraordinary attention to detail an related with variety professions, its responsibilities and the required qualifications. Updated knowledge about job openings in all sector and ability to access all sources providing information about job opening.
Employment Specialist 08/1998 to 06/2012
Cuban American National Council, Inc €“ Miami, Fl
- Conducted outreach/recruitment efforts in the community as needed
- Developed an individual training plan and conducted ongoing assessment of participants training progress and maintain appropriate participant record as well as enter information into the computer.
- Provided Acculturation and Work Readiness to new clients.
- Analyzed and provided support services to clients in need.
- Assisted job seekers in developing a resume and conducted mock interview as a tool to assisted them for the real experience of facing an interview and answer possible questions. ·
- Met monthly placement performance and retention benchmarks of 10 and 15 placements respectively.
- Provided counseling to participants in training to maximize the likelihood of completion of the program in a timely manner.
- Provided employment and employment counseling to participants during or after training. ·
- Perform career counseling to job seeker and help them make appropriate career decisions.
Job Developer 01/1998 to 07/1998
Miami Dade Refugee Training Program €“ Miami, FL
- Conducted outreach refugee recruitment
- Selected applicants of job openings, and refer qualified applicants to prospective employers.
- Contact employers to verify referral results.
- Record and evaluate various pertinent data.
Job Developer 08/2013 to Current
Lutheran Services €“ Miami, Fl
- Initiates and maintains ongoing personal contacts with a variety of business and industry representatives and job placement/training agencies to promote programs for participant placement.
- Makes cold calls to potential employers; explains the benefits and employment support services provided by programs to employers, including addressing employer’s special needs
- Researches Internet, newspapers, agencies, and other resources for job leads
- Locates jobs for participants who have successfully completed training programs
- Collects data from employers related to job orders including job requirements and skills
- Matches job skills with applicant qualifications
- Refers qualified applicants to employers and conducts necessary follow-up when applicants are placed in positions.
- Keeps updated regarding job fairs and Internet resources
- Researches various resume programs
- Participates in outreach and recruitment activities by coordinating and attending job fairs.
Bachelor of Arts: 1993 Universidad de la Habana – Havana, IL
Bachelor Degree: Business Administration Economics August 1993 –
- Employee of the month
- Facilitated and participated Job Fairs
- Understanding Evaluation