Credentialing Representative Resume Samples
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Credentialing Representative Resume Samples
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CK
C Kautzer
Chelsey
Kautzer
999 Fredy Prairie
Phoenix
AZ
+1 (555) 601 7872
999 Fredy Prairie
Phoenix
AZ
Phone
p
+1 (555) 601 7872
Experience
Experience
Houston, TX
Credentialing Representative
Houston, TX
Lind LLC
Houston, TX
Credentialing Representative
- Perform credentialing of applications and authorizations for medical, dental, and BHO providers
- Send emails or make outbound calls to provider to collect a completed form
- Works independently
- May coordinate work of other team members
- Work with team to solve complex problems
- Works with team to solve complex problems
- Process provider termination requests
Houston, TX
Associate Credentialing Representative
Houston, TX
Koss Group
Houston, TX
Associate Credentialing Representative
- Manage credentialing inventory, reports and projects to ensure all established time frames for completing work, reports and projects are met
- Screen incoming applications and paperwork for completeness and accuracy and sends necessary paperwork to credentialing vendor
- Contact providers or representatives by telephone or in writing to obtain additional information while processing their enrollment applications
- Credential and re-credential providers
- Create and distribute monthly reports as assigned and handle complex and unusual or high-level credentialing issues
- Depending on level, investigate interim license actions
- Participate in projects which streamline, automate, or otherwise enhance credentialing functions
present
Boston, MA
Senior Credentialing Representative
Boston, MA
Littel Inc
present
Boston, MA
Senior Credentialing Representative
present
- Plan, prioritize, organize and complete work to meet established objectives
- Some work is completed without established procedures
- Work is frequently completed without established procedures
- Provide feedback to reduce errors and improve processes
- Monitor provider credentials to ensure providers remain up to date with state and/or federal regulations
- Develop and maintain relationships with market leadership
- Process and/or monitor annual renewals for all licensed providers
Education
Education
Georgetown University
Skills
Skills
- Psychological skill: Ability to maintain focus, flexibility, and organization. Strong attention to detail; Comfortable working in fast paced environment
- Interpersonal and Communication skill: Basic customer service skills; basic written and verbal communication skills
- Technical skill: Basic office computer skills with an aptitude to learn; Ability to navigate on the web securely and within terms of such website
- Prior professional work experience: 1 year basic work experience
- Excellent organization skills with the ability to prioritize assigned duties in an efficient amount of time
- Ability to pay close attention to detail and produce extremely accurate work
- Knowledge and skills in using personal computers (Windows) with a strong emphasis on Microsoft Office Programs- Outlook, Word, Excel and also Adobe Acrobat
- Good oral and written communication skills
- Ability to maintain confidentiality
- Experience in a position requiring strong interpersonal and oral communication skills including telephone etiquette
6 Credentialing Representative resume templates
Read our complete resume writing guides
1
Credentialing Representative Resume Examples & Samples
- Mailing of applications
- Intake application review
- Processing Credentialing Request Forms (CRF)
- Council for Affordable Healthcare (CAQH) application review/profiles
- Preliminary review of credentialing applications
- Monitor and process expiriables on an ongoing basis
- Process provider termination requests
- Process ongoing monitoring of Medicare/Medicaid Opt Out/OIG/SAM
- Generate and distribute reports on a weekly and monthly basis
- Verify licensure via online sources
- Assist with multiple RN applications with internal RN employees
- Anticipate customer needs and proactively identify solutions
- Prioritize work tasks
- Participate in audits
- Ability to work independently and with a team
- Ability to adapt well in a changing environment
- Experience with ANY of the following: CAQH, PECOS, internal credentialing, NCQA Standards related to credentialing, or CMS Regulations related to credentialing
2
Senior Credentialing Representative Resume Examples & Samples
- Complete and submit applications for enrollment with Medical, Medicaid, and various other
- Commercial Plans
- Mailing of applications via USPS and/or email
- Data entry and maintenance into database in accordance with internal policies and procedures
- Maintain assigned market/region in all aspects of payor enrollment/external credentialing
- Independently and as a team solve complex problems
- Act as technical resource to others in own function
- Provide utmost customer service
- CPCS Certification
- MS Access – create basic queries
- Experience with Crystal Reports
3
Credentialing Representative Resume Examples & Samples
- Sometimes act as a technical resource to others in own function
- Solve moderately complex problems on own
- Work with team to solve complex problems
- Provider Credentialing experience
- Experience working with compliance workflows and processes including NCQA policies and practices
- Experience in researching and applying government regulatory information
- Experience with NDB
4
Credentialing Representative Resume Examples & Samples
- Credentialing experience required
- 1+ years of experience working with Compliance Workflows and Processes including NCQA Policies and Practices
- 1+ years of experience in researching and applying Government Regulatory information
5
Credentialing Representative Resume Examples & Samples
- Apply knowledge/skills to a range of moderate issues
- Demonstrate a breadth of knowledge/skills in own area
- Sometimes acts as a technical resource to others in own function
- Proactively identify solutions
- Act as the primary credentialing contact and provide credentialing support to regional health plans. This includes but is not limited to
- 1+ year of experience working with Microsoft Word and Excel
- Experience in Researching and Applying Government Regulatory Information
- Experience working with Compliance workflows and processes
- Health Care Provider or Home and Community Based Services Credentialing experience
6
Credentialing Representative Resume Examples & Samples
- TransUnion Sales Representatives, Vice Presidents and/or GVPs
- Corporate Compliance and Legal
- Data Acquisition Services
- Corporate Investigations Department
- Onsite inspection and other business information service providers
7
Credentialing Representative Resume Examples & Samples
- Reviews applications for completeness, identifying discrepancies and potential issues
- Conducts verifications and queries as required by regulatory standards and departmental policies and procedures
- Responsible for timely and accurate multi - system data entry of provider additions, deletions and changes in accordance with departmental policies and procedures
- Maintains a working knowledge of contracting policies, procedures and processes, in an effort to provide cross - functional support to the contract services team on an as - needed basis
- Prepares and distributes reports in accordance with departmental procedures
- Assists in Credentialing Committee preparation, records minutes and promptly performs follow up actions as requested by Committee members as needed
- Meets or exceeds departmental timeframes and quality metrics on a consistent basis
- Maintains knowledge of credentialing policies and procedures and NCQA, URAC and CMS regulatory requirements
- 1+ years of administrative, database and / or data entry experience
- Ability to maintain confidentiality while working with sensitive information
- Detail - oriented, well - organized and have the ability to multi - task effectively
- CPCS certification or willingness to pursue certification
- 1+ years of experience in managed care credentialing in a managed health care setting or related environment
- Knowledge of Microsoft Office software applications (Word, Excel and Access)
8
Credentialing Representative Resume Examples & Samples
- Adhere to protocol as outlined in the Disclosure Unit Resource Library to
- Process forms per assignment in National Disclosure Database
- Send emails or make outbound calls to provider to collect a completed form
- Utilized PLINX and NPI Registry to search for provider information
- Enter data in Database and tracking grids
- Process a minimum of 20 forms per day
- Previous experience in healthcare insurance, managed care, provider relations or credentialing
9
Senior Credentialing Representative Resume Examples & Samples
- Apply knowledge / skills to complex activities
- Demonstrate a depth and breadth of knowledge / skills in own area and is often able to apply these outside of own function
- Often act as a technical resource to others in own function
- Solve complex problems on own; proactively identify new solutions to problems
- Candidate will be familiar with standard NV credentialing forms
- Intermediate level of proficiency with credentialing software programs such as CACTUS or Webtrack
- 2+ years of experience working with compliance workflows and processes including NCQA policies and practices
- 2+ years of experience in researching and applying government regulatory information
- Ability to work independently and remain on task
- Credentialing experience in physician setting
10
Credentialing Representative Resume Examples & Samples
- Credentialing of physical health providers
- Work is frequently completed without established procedures
- Healthcare provider credentialing experience
11
Senior Credentialing Representative Resume Examples & Samples
- Demonstrate a depth and breadth of knowledge/skills in own area and is often able to apply these outside of own function
- 1+ years of experience within Healthcare
- Intermediate level proficiency with Microsoft Excel, Word, and Outlook
- 1+ years of experience with credentialing
12
Credentialing Representative Resume Examples & Samples
- Apply knowledge / skills to a range of moderately complex activities
- This position involves attention to detail in processing credentialing applications according to regulatory requirements. It also involves interaction with contracting department and provider relations. It requires strong communication skills, as the role requires ongoing communication with providers and departments throughout the organization
- Strong interpersonal and oral communication skills including telephone etiquette
- Associates Degree or higher
- 1+ years of healthcare provider credentialing, quality or compliance experience
13
Credentialing Representative Resume Examples & Samples
- 1+ year of Healthcare Provider Credentialing experience
- Experience in researching and applying Government Regulatory Information
- Intermediate level of proficiency with Microsoft Excel and Word
14
Provider Enrollment Credentialing Representative Resume Examples & Samples
- Customer Service, written and communication skills
- Ability to prioritize and organize multiple tasks
- Skills in technology such as MS Office Excel, Word
- Ability to maintain confidentiality, work efficiently in a team environment with Physicians, APP's leadership, clinical staff and all employees of the division
- Minimum 2 year experience in payer enrollment/credentialing required for commercial and work comp payers
15
Credentialing Representative Resume Examples & Samples
- Provider Credentialing experience or healthcare experience
- Database skills including querying, reporting and document generation
- Informational research skills
- Previous experience in a production based environment
- Ability to manage multiple tasks and triage responsibilities
- People skills and effective communicator
16
Credentialing Representative Resume Examples & Samples
- Perform credentialing of applications and authorizations for medical, dental, and BHO providers
- Auditing credential files before presenting to the Credentialing Committee
- Work independently as well as with a team to identify, track, and resolve application issues
- Utilize credentialing sites and services to maintain compliance through NCQA
- Maintain accuracy throughout the credentialing process to minimize re-work status and errors
- Estimated 35-45 applications on a monthly basis
- Intermediate proficiency using MS Word and MS Excel, with the ability to create/edit documents, use sort/filter functions, and utilize data entry skills
- Experience using phone and computer as primary job tools
- 2+ years of experience in credentialing healthcare providers
17
Senior Credentialing Representative Resume Examples & Samples
- Proactively identify solutions to non-standard requests
- Moderate work experience within own function
- 3+ years of previous healthcare credentialing experience
- Intermediate (or higher) level of proficiency with Microsoft Word and Excel
- Knowledge of NCQA and CMS standards
- Previous experience obtaining credentialing information
- Ability to work independently or in group project while remaining on task
18
Credentialing Representative Resume Examples & Samples
- 3+ years of healthcare provider credentialing experience
- Intermediate level of proficiency with Microsoft Word and Microsoft Excel
- Available Monday through Friday from 7:00 am to 4:00 pm (slightly flexible on start and end times)
- Experience with organization and planning
- Experience in a position requiring strong interpersonal and oral communication skills including telephone etiquette
- Experience with research and analysis
19
Senior Credentialing Representative Resume Examples & Samples
- Facilitates the Provider On-boarding process to include receipt and review of the provider file and supporting documentation, and timely and substantive communication with all internal and external departments and agencies to ensure timely on-boarding
- Prepare and coordinate the processing of credentialing and re-credentialing applications
- Facilitate the application process for all new and existing providers to include facility credentialing (HDO’s)
- Work with MD, DO, DPM, Nevada State Board of Nursing, DEA and all other entities to facilitate the licensing process
- Monitor provider credentials to ensure providers remain up to date with state and/or federal regulations
- Track and monitor provider licenses including preparation of documents required to obtain or maintain all applicable provider licenses
- Maintain data, to include licensure, certification, and CME hours in the confidential credentialing and UHG database(s)
- Demonstrate knowledge of computer software applications to include MS Office, Visual Cactus, NPDB, and CertiFacts
- Process and/or monitor annual renewals for all licensed providers
- Work closely with the QI and QM departments to ensure compliance with NCQA, CMS, state, and other regulatory agencies
- Advanced computer skills including: MS Access
- Strong organization and planning skills
- Basic level of research and analytical skills
- Must have the ability to prioritize multiple tasks and perform complex clerical and administrative functions with minimal to no supervision
20
Credentialing Representative Resume Examples & Samples
- Demonstrate great depth of knowledge / skills in own function
- Experience with Microsoft Office (Outlook, Word, and Excel)
- Experience with NDB or similar platform
21
Associate Credentialing Representative Resume Examples & Samples
- Credential and re-credential providers
- Contact providers or representatives by telephone or in writing to obtain additional information while processing their enrollment applications
- Screen incoming applications and paperwork for completeness and accuracy and sends necessary paperwork to credentialing vendor
- When necessary performs credentialing verifications and loads provider to appropriate networks and credentialing information to the provider database
- Manage credentialing inventory, reports and projects to ensure all established time frames for completing work, reports and projects are met
- Depending on level, train credentialing team in the use of various systems, software, databases, processes and procedures
- Create and distribute monthly reports as assigned and handle complex and unusual or high-level credentialing issues
- Support projects, audits, business partners, internal departments and external clients
- Represent department as the Subject Matter expert
- Pull and research necessary documentation for audits
- Support updates necessitated by our business partners, internal departments and external clients
- Provide customer oversight for our customers who have unique requirements and timelines to ensure compliance
- Depending on level, investigate interim license actions
- Participate in projects which streamline, automate, or otherwise enhance credentialing functions
- 0-1 years of experience
- Experience in Provider Data Management, Customer Services or Claims
- Microsoft office experience (i.e. Word, Excel, PowerPoint, etc.)
- A familiarity with credentialing processes and the URAC standards
- Experience in the use of ULTRA and Dental Provider File systems
- Experience with the Customer Service inquiry system or claims processing concepts
- Good written and verbal communication
- Proficiency in the use of the Provider file and the credentialing of providers
- Proven diplomacy and a professional demeanor for effective communication with provider offices, internal personnel, vendors, accounts and committees
- Strong written communication and presentation skills are essential
22
Senior Credentialing Representative Resume Examples & Samples
- 2+ years of previous healthcare credentialing experience
- Intermediate (or higher) level of proficiency with Microsoft Word and Microsoft Excel
- Knowledge of CMS
- Knowledge of NCQA
23
Credentialing Representative Resume Examples & Samples
- 1+ years of healthcare provider credentialing experience
- Credentialing software experience (Visual Cactus)
- Interpersonal and oral communication skills including telephone etiquette
24
Senior Credentialing Representative Resume Examples & Samples
- 5+ years of healthcare provider credentialing experience
- 3+ years of experience of research and analytical skills
- Proficient in MS Office including MS Excel and MS Word
- Ability to work independently and remain on task with minimal supervision
25
Credentialing Representative Resume Examples & Samples
- Facilitate the initial and reappointment hospital credentialing process for new and existing Physicians and Advanced Practice Providers
- Work closely with hospital medical staff office & state licensing boards to ensure providers are able to begin working by his/her contracted start date
- Prepare state, hospital & USACS required written supervision and collaborative agreements for Advanced Practice Providers, facilitating completion, submission and/or properly housing completed agreements
- Follow up and maintain effective communication with clinicians, hospital medical staff offices and state licensing boards to ensure the necessary information is gathered and processed within specified time constraints
- Identify, research and resolve credentialing issues. Responsible for communicating any potential start date delays to providers, department manager and medical director in a timely manner
- Record detailed notes in credentialing database and/or site spreadsheets to track current application status for individual and department utilization
- Identify emerging issues and communicate to credentialing team lead and/or manager with recommendations for resolutions
- Collect hospital and insurance carrier required credentialing documents from providers and properly enter information in credentialing database
- Other special projects as assigned
- Ability to organize and prioritize job tasks and requirements
- Ability to effectively perform in a multi-task work environment
- Excellent organization skills with the ability to prioritize assigned duties in an efficient amount of time
- Ability to effectively use oral and written communication skills with clinicians, external agencies and management in a courteous and professional manner. Must have knowledge of correct English, proper grammar and spelling
- Knowledge and skills in using personal computers (Windows) with a strong emphasis on Microsoft Office Programs- Outlook, Word, Excel and also Adobe Acrobat
- Ability to maintain patience and composure in difficult situations
- Ability to work well under pressure and meet strict deadlines
- Ability to pay close attention to detail and produce extremely accurate work
- Ability to exhibit a commitment to teamwork, supporting alignment with company and department goals and objectives, assisting others to develop their knowledge of the company and department, and adapting to changes in a positive manner
26
Credentialing Representative Resume Examples & Samples
- Analytical skill: Ability to interpret and analyze basic business information; Ability to identify, articulate, and solve basic problems; Ability to determine when to escalate issues
- Psychological skill: Ability to maintain focus, flexibility, and organization. Strong attention to detail; Comfortable working in fast paced environment
- Interpersonal and Communication skill: Basic customer service skills; basic written and verbal communication skills
- Routine interaction with internal business unit team members and/or external business officers
