Credentialing Analyst Resume Samples
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Credentialing Analyst Resume Samples
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Don
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4316 Klein Track
Houston
TX
+1 (555) 157 3264
4316 Klein Track
Houston
TX
Phone
p
+1 (555) 157 3264
Experience
Experience
San Francisco, CA
Credentialing Analyst
San Francisco, CA
Russel-Nolan
San Francisco, CA
Credentialing Analyst
- Update various internal systems with credentialing progress and final result
- Assess team member marriage data by reviewing Credentialing Review in order to provide direction and guidance for prompt resolution of potential delay or cancellation issues
- Ensure all business documents and supporting research are accurate, in good standing, and verified and included in the file for future audits by outside agencies such as the FTC, AVC, and data vendors
- Support evaluation of team member task performance and competencies through observation and feedback to Credentialing Manager assisting in the identification of opportunities for goal alignment and continuous improvement
- Promote a team atmosphere within the Credentialing Department by modeling strong customer service, morale and team work philosophies in order to heighten engagement and retention
- Extensive research via internet to validate legitimacy and currently of business and other tools such as criminal records check industry lists, business credit reports in order to determine pass/fail status
- Serve as mentor/peer advisor for new hires
Boston, MA
Onsite Credentialing Analyst
Boston, MA
Rowe, Mante and Pollich
Boston, MA
Onsite Credentialing Analyst
- Observe on-the-job performance and approach of self and team members
- Address first level escalation issues by investigating and troubleshooting with internal and external stakeholders in order to execute win-win solutions
- Establish access level for approved applications based on credentialing, FCRA, GLBA, DPPA, and vendor contract rules
- Assist in facilitation of action plan project tasks in order to communicate and implement engagement-driving programs and activities
- Perform credentialing steps per documented procedures
- Review applications for correctness and completeness
- Conduct ad-hoc desk audits by reviewing healthcare professional files for accuracy
present
New York, NY
Onsite Credentialing Analyst Telecommute
New York, NY
Bruen-Mosciski
present
New York, NY
Onsite Credentialing Analyst Telecommute
present
- Analyst will execute unannounced pharmacy inspections to ensure compliance with state and/or federal regulations, codes and statutes
- Prepare comprehensive case investigation reports including evidence and findings
- Analyst will verify current on-hand inventory, as well as acquire a complete listing of wholesalers
- Identify gaps and inefficiencies in existing policies and procedures and suggest effective and efficient solutions
- Analyst will perform background checks on all employees/entities, as well as further analytics to identify past/present associations with pharmacies terminated from the Pharmacy Network and/or engagement in FWA activity
- Analyst will verify the validity of all addresses associated with Pharmacy including, but not limited to, Google Map’s searches and/or on-site visits
- Obtain and analyze claims billing and payment data as necessary in the course of conducting an investigations of criminal or civil fraud
Education
Education
Bachelor’s Degree in Accuracy Regarding Data Entry
Bachelor’s Degree in Accuracy Regarding Data Entry
Kaplan University
Bachelor’s Degree in Accuracy Regarding Data Entry
Skills
Skills
- Ability to articulate roadblocks in a professional, factual format
- Polished and professional demeanor
- Excellent verbal and written communication
- Detail-oriented and organized
- Conduct ad-hoc desk audits by reviewing healthcare professional files for accuracy
- Ability to multitask
- Attention to detail
- Proficiency in Microsoft Outlook and Excel
- Willingness to take accountability
- 3+ years of credentialing experience
9 Credentialing Analyst resume templates
Read our complete resume writing guides
1
Onsite Credentialing Analyst Resume Examples & Samples
- Analyst will execute unannounced pharmacy inspections to ensure compliance with state and/or federal regulations, codes and statutes
- Analyst will verify the validity of all addresses associated with Pharmacy including, but not limited to, Google Map’s searches and/or on-site visits
- Obtain and analyze claims billing and payment data as necessary in the course of conducting an investigations of criminal or civil fraud
- Prepare comprehensive case investigation reports including evidence and findings
- Identify gaps and inefficiencies in existing policies and procedures and suggest effective and efficient solutions
- Bachelor's Degree (or higher) or High School Diploma/GED with 2+ years of experience working in a Compliance Organization related to Pharmacy setting, or practice in Fraud Investigation Unit, Pharmacy Benefits Manager (PBM) and/or Law Enforcement Agency
- 3+ years of Pharmacy experience
- Proficient in Microsoft Word and Excel (formulas, VLOOKUPS, and pivot tables)
- Must be able to travel 75% of the time nationwide with overnight stay up to 5 days Monday-Friday
- Knowledge of top industry dispensed medications, Federal Requirements, and Specific State Requirements to perform the Credentialing review
- Industry Certifications, i.e. CFE, AHFI, etc
- Previous experience with Government Healthcare Programs (Medicare, Medicaid and/or TriCare)
- Knowledge of Federal/State Requirements and Administrative Rules for Pharmacies
- Proficient in Microsoft Access
- Excellent attention to detail and concise documentation
2
Onsite Credentialing Analyst Telecommute Resume Examples & Samples
- Analyst will work closely with Credentialing manager to validate that OptumRx Network pharmacies meet and maintain the appropriate credentialing requirements, as well as quality management standards to serve as a Pharmacy Provider for OptumRx
- Analyst will perform background checks on all employees/entities, as well as further analytics to identify past/present associations with pharmacies terminated from the Pharmacy Network and/or engagement in FWA activity
- Analyst will validate purchase invoices and/or other applicable documentation, as well as correlating billing records
- Analyst will verify current on-hand inventory, as well as acquire a complete listing of wholesalers
- Bachelor Degree or HS Diploma/GED with 2+ years of experience working in a Compliance Organization related to Pharmacy setting, or practice in Fraud Investigation Unit, Pharmacy Benefits Manager (PBM) and/or Law Enforcement Agency
- Certified Pharmacy Technician (CPhT)
- Proficient in MS Word and Excel (formulas, VLOOKUPS, and pivot tables)
- Proficient in MS Access
3
Onsite Credentialing Analyst Resume Examples & Samples
- Bachelor's Degree or Higher or a High School Diploma/GED with 2+ years of experience working in a Compliance Organization related to Pharmacy setting, or practice in Fraud Investigation Unit, Pharmacy Benefits Manager (PBM) and/or Law Enforcement Agency
- Proficient in MS Word, and Excel (formulas, VLOOKUPS, and pivot tables)
- Previous experience with Government Healthcare Programs (Medicare, Medicaid and/or Tricare)
4
Credentialing Analyst Resume Examples & Samples
- Review applications for correctness and completeness
- Perform credentialing steps per documented procedures
- This includes obtaining background information regarding licensing, industry standing, appropriate use, etc. on applicants
- Extensive research via internet to validate legitimacy and currently of business and other tools such as criminal records check industry lists, business credit reports in order to determine pass/fail status
- Establish access level for approved applications based on credentialing, FCRA, GLBA, DPPA, and vendor contract rules
- Ensure all business documents and supporting research are accurate, in good standing, and verified and included in the file for future audits by outside agencies such as the FTC, AVC, and data vendors
- Contact external customers via phone and/or email to verify information and request additional documentation as appropriate
- Update various internal systems with credentialing progress and final result
- Review of abbreviated credentialing process by analyst I, coaching analyst I when errors are detected, making final decision on pass/fail
- Additional duties as required
- High School, College degree preferred 2+ Years’ experience
- Ability to follow documented processes and procedures yet think interpretively
- Ability to work with limited supervision
- Ability to meet deadlines and coordinate multiple tasks
- Proven ability to meet Credentialing TAT
- Meet Credentialing productivity and accuracy standards 9) Proficiency in full-credentialing processes and procedures
5
Credentialing Analyst Resume Examples & Samples
- 2 years of experience with the Air Force Credentialing Program and attaining credentials
- Experience as a former non-commissioned officer (NCO) in the US Air Force
- Experience with methods for assessment of training processes and systems
- Experience with using Microsoft Office
- Knowledge of civilian credentialing and its ties to Air Force requirements
- 5 years of experience in working with the Air Force Automated Education Management System (AFAEMS) and Military Tuition Assistance (MilTA) and related voluntary education processes
- Experience at the CCAF
- AA or AS degree from the Community College of the Air Force (CCAF)
6
Credentialing Analyst Resume Examples & Samples
- 3+ years of credentialing experience
- 1+ years of Hospital credentialing experience
- Detail-oriented and organized
7
Credentialing Analyst Resume Examples & Samples
- Coordinate response to assigned client regulatory audits, Joint Commission/TWSM documentation, 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
- Consult clients on Credentialing best practices by making recommendations on requirements expectations and realistic start dates to streamline submission and placement processes in order to increase fill rate of qualified HPs
- Research new requirements (by Joint Commission, OSHA, and others) that may impact the industry in order to present proposals to leadership that clarify appropriate action plans that will address the requirements with least resources and expense
- 4 years customer service experience or equivalent combination of education and experience
- 1 to 3 years previous experience in hospital setting
8
Credentialing Analyst Resume Examples & Samples
- Detailed Review of Healthcare Providers’ submitted requirements including licensure, certifications, and other critical documents to determine document status
- Communicate directly with internal and external customers and reinforce Joint Commission, federal and state mandates to to ensure all requirements are completed accurately and timely, providing excellent customer service to all internal and external parties
- Assist with the client site credentialing process including gathering and documenting facility requirements and assisting healthcare professionals in obtaining necessary requirements to ensure assignment start dates are met
- Ensure accurate and timely data submission in all appropriate internal and external databases
- 4+ years customer service experience or equivalent combination of education and experience
- Healthcare or hospital experience
9
Credentialing Analyst Resume Examples & Samples
- Responsible for achieving full compliance for healthcare professionals in a timely manner prior to and throughout their assignments
- Assesses healthcare professional credentials for deficiencies to standard and communicates to production when a healthcare professional cannot be accepted
- Communicates expiring documents to the assigned Recruiter and assist as necessary to ensure that updated documentation is collected
- Communicates directly with internal and external customers to ensure all requirements are completed accurately and timely, providing excellent customer service to all internal and external parties
- Coordinates aspects of drug screen testing, criminal background checks and case logs according to site credentialing requirements
- Assists with the site credentialing process including gathering and documenting facility requirements and assisting healthcare professionals in obtaining necessary requirements to ensure assignment start dates are met
- Preferred: 1-3 years previous experience in a hospital setting
- Preferred: Credentialing experience
- Ability to prioritize effectively in a fast-paced environment
- Effective communication skills and professional demeanor when representing the Company to clients, healthcare professionals or other vendors
- Effective organizational skills with an attention to detail
- Accuracy in assessment and documentation of credentials
10
Credentialing Analyst Resume Examples & Samples
- Proficiency in Microsoft Outlook and Excel
- Willingness to drive issues to resolution without exceptions
- Ability to articulate roadblocks in a professional, factual format
- Willingness to take accountability
- Ability to prioritize based on business needs
11
Credentialing Analyst Resume Examples & Samples
- Requires a H.S. diploma; at least 3 years experience in a managed care environment; or any combination of education and experience, which would provide an equivalent background
- Certified Provider Credentialing Specialist and college course work preferred
- Provider relations required
- Claims experience preferred
- Excellent oral and written communication required
- FACETS software experience preferred
- MS Outlook, Word, and Excel software required
12
Credentialing Analyst Resume Examples & Samples
- Track record of prioritizing work, multi-tasking, and managing workload efficiently
- Proficiency with MS office suite required
- College degree or equivalent work experience preferred
- Possesses a working knowledge of Business Review/Credentialing processes, EPDB, EPC and CARDS desired
13
NV MCD Credentialing Analyst Resume Examples & Samples
- Proficiency with MS office suite is required
- Possesses a working knowledge of Business Review/Credentialing processes, EPDB, EPC and CARDS
- Ability to consistently meet and/or exceed performance/production goals
- Strong organization and communication skills
14
Credentialing Analyst Resume Examples & Samples
- Possesses a working knowledge of Business Review/Credentialing processes, EPDB, NETBUS, E2I, ACI Portal
- Knowledge of managed care business and healthcare environment a plus
- Knowledge of Contracts Administration to ensure appropriate contract implementation requirements are met
15
Credentialing Analyst Resume Examples & Samples
- High School, College degree preferred
- 2+ Years’ experience
- Meet Credentialing productivity and accuracy standards
- Proficiency in full-credentialing processes and procedures
16
Credentialing Analyst Resume Examples & Samples
- Ensures accurate verification of applicants and existing customer information to determine a pass or fail by following documented policies and procedures to uphold regulatory requirements, data provider contractual requirements, and internal policies to ensure legitimate customers and to reduce the likelihood that accounts will be used for illegal activity or for non-permissible purposes within stated service level agreements. 80%
- Bachelor’s degree or equivalent experience required
- Credentialing experience preferred but experience working within FCA regulated environment is required
- Detail oriented with a critical degree of accuracy regarding data entry and analysis, ability to deal with confidential data
- Proficient knowledge of computer-based software such as Windows, Internet Explorer, Microsoft Office and web-based products and tools. Will utilize relevant LexisNexis products and tools (e.g. MBS, Accurint, etc.) and external verification tools (SOS, etc.) on daily basis
- Excellent oral and written communications – experience in customer service environment preferred
17
Credentialing Analyst Resume Examples & Samples
- 2 years of experience in credentialing programs and attaining credentials
- Experience with using various methods for the assessment of training processes and systems
- Experience with clerical, office, or other work in communicating with individuals at different levels to assist and provide information
- Knowledge of civilian credentialing and its ties to Air Force enlisted career fields and specialties
- Experience as a former Non–Commissioned Officer (NCO) in the US Air Force
- Experience in working with the Air Force Automated Education Management System (AFAEMS), Military Tuition Assistance (MilTA), and related voluntary education processes
18
Temporary Credentialing Analyst Resume Examples & Samples
- 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
- Communicate timely updates of HP document status with all internal stakeholders (e.g. Recruitment, Account Management) via AMIE, email, phone, etc. to facilitate a team approach to gathering all required documents
- Create urgency with Healthcare Providers via email and phone, to encourage timely and accurate document submission by establishing target dates and monitoring document submission progress in order to deliver comprehensive documentation to the client facility for an on-time assignment start date
- Facilitate quick book (QB) process for assigned facilities by taking lead role to collaborate with Account Managers, Recruiters and Housing department in order to determine reasonable start dates
- Collaborate with Contracts Credentialing Analyst to review all incoming new client contracts or contract revisions for Credentialing requirements, for assigned facilities in order to identify unique requirements
- Negotiate with client facility to reconsider unusual or uncustomary requirements by emphasizing the value and experience of Quality Services Department with client facilities in order to minimize disruption of placements and optimize fill rate
- Maintain up-to-date and accurate facility database including updated contact information, new requirements and client correspondence by following up regularly with clients in order to optimize service coverage and prevent gaps in service delivery
19
Senior Credentialing Analyst Resume Examples & Samples
- Process Massachusetts LTSS Provider Medicaid applications, revalidations, and profile updates
- Perform verbal, written and on-line primary source verification for individual and organizational providers, including but not limited to, state licensure, controlled substance registrations, accreditation status and exclusion database checks
- 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
- Monitor work queue to ensure enrollments are processed within expected turnaround times
- Meet or exceed production and quality standards. Perform unscheduled LTSS Provider site visits to verify compliance with regulations (60% local travel)
- Gather and document business requirements from client
- Create standard operating procedures (SOPs) and training documentation to support enrollment, revalidation, and update processing
- Bachelor's degree in Business, Finance, Health Administration, related field or equivalent work experience
- 3+ years of experience in analysis of business processes and workflow and providing process improvement recommendations
- Experience gathering requirements from clients
- Experience creating standard operating procedures (SOPs) and training documentation
- Intermediate level of proficiency with PC based software programs (Excel, PowerPoint, Word, and Visio)
- Ability to communicate analysis including trends and opportunities to clients and the business in writing and verbally
- Ability to present complex data clearly and concisely to external clients
- Salesforce experience
- Enrollment and credentialing experience
- Experience working with and communicating with providers
20
Credentialing Analyst Resume Examples & Samples
- Operate autonomously of department leadership/oversight by making independent decisions in order to fulfill highest production standards in support of team and division needs
- Appraise steps, approach and progress of newer team members throughout work process in real time in order to expedite production by increasing knowledge and transferring new skills
- Conduct ad-hoc desk audits by reviewing healthcare professional files for accuracy
- Assess team member marriage data by reviewing Credentialing Review in order to provide direction and guidance for prompt resolution of potential delay or cancellation issues
- Address first level escalation issues by investigating and troubleshooting with internal and external stakeholders in order to execute win-win solutions
- Support evaluation of team member task performance and competencies through observation and feedback to Credentialing Manager assisting in the identification of opportunities for goal alignment and continuous improvement
- Coach on performance and behavioral issues directly with team members by investigating and diagnosing root cause in order to determine appropriate course of action
- Promote a team atmosphere within the Credentialing Department by modeling strong customer service, morale and team work philosophies in order to heighten engagement and retention
- Assist in facilitation of action plan project tasks in order to communicate and implement engagement-driving programs and activities
- Serve as mentor/peer advisor for new hires
- Observe on-the-job performance and approach of self and team members
- Exceptional performance in Credentialing Analyst position
- 1-3 years in hospital setting
- 1 year leadership or supervisory experience or equivalent combination of education and experience
