Credentialing Coordinator Resume

CREDENTIALING COORDINATOR / SPECIALIST

Ten years of credentialing experience working in corporate and healthcare office environments. Expert in coordinating provider applications and the re-credentialing process. Solid knowledge of NCQA and DHS credentialing standards. Proven ability to work independently and efficiently with superior results.

Collaborate with medical providers, health plans, credentialing verification office, and credentialing committees to drive workflow efficiencies and to ensure regulatory compliance, in the areas of:

  • Analyzing reports and maintaining a credentialing database
  • Processing credentialing files, licences, and DEA renewals
  • Monitoring credentialing applications
  • Developing internal policies and procedures
  • Overseeing audits for managed care
  • Resolving credentialing issues
  • Agency Relations: CMS, NCQA, DMHC, ICE, DHCS
  • Proficient in ECHO System

PROFESSIONAL EXPERIENCE

MED VERIFICATION SYSTEMS – Cincinnati, OH | 2012 – Present
Credentialing Specialist
• Review provider files for appropriate documentation required for the credentialing process.
• Prepare files for audits and maintain electronic data input activities.
• Coordinate credentialing and re-credentialing applications and conduct document research.
• Manage files in relation to the credentialing of network providers: application, contracts, current physician licenses, DEA licenses, malpractice insurance, board certifications and other pertinent forms.
• Prepare documents for Credentialing Committee review.
• Forward applications to providers and ensured accuracy and completeness of information.
• Interface between providers and hospital to collect required information.
• Perform credential verification and request information from appropriate data banks.
• Submit applications to manager, medical director and Credentialing Committee for review.

HOLLIS HEALTH- Cleveland, OH  |  2007 – 2012
Credentialing Coordinator
• Monitored procedures and activities related to credentialing and re-credentialing of network providers.
• Communicated with providers and field associates regarding credentialing status and information.
• Assembled and prepared credentialing information for appropriate committees.
• Received Managed Care and PPO provider applications and re-credentialing applications.• Maintained and updated database to track applications and the credentialing process.• Provided administrative support such as generating and distributing mailings.
• Participated in the appointment process and coordinated medical staff meetings.

EDUCATION

Ohio State University
B.S., Business Administration – Concentration in Health Care

COMPUTER SKILLS

MS Word, Excel, PowerPoint; proprietary health care databases

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