E D WA R D W A L K E R

C ONTACT I NFO : (* * * ) 5 7 9 - 7 6 6 7 / L o v e 8 2 k @ g m a i l . c o m

PROFESSIONAL SUMMARY: Over ten (10) years plus of experience Credentialing medical provider's applications.

Monitored and updated Demographic in (Cactus Data Base); effectively communicated with Providers and

staff. Working knowledge of Microsoft Office Suite and Health Insurance Guideline / HIPAA; maintained the

Credentialing database and tracked all new providers in network / existing Providers. Examined Credentialing /

re-Credentialing / Ancillary's activities; prepared and completed provider files for Chief Medical Officer and

Credentialing Committee as needed.

E DUCATION

ACE COMPUTER TRAINING CENTER NEW YORK, NY

CERTIFICATE: Medical Billing and Coding 2007

MONROE COLLEGE NEW YORK, NY

CERTIFICATE: Computer Software Application 2006

NEW YORK URBAN LEAGUE, INC QUEENS, NY

CERTIFICATE: Information Processing Training 1992

E H

MPLOYMENT ISTORY

SUNY DOWNSTATE HOSPITAL- LYNX TECHNOLOGY AGENCY 2/14 - 4/14

CREDENTIALING SPECIALIST BROOKLYN, NY

Audit Cred/Re-credentialing provider files

Updated providers current data in (Cactus)

Verified Hospital Privileges, DEA, NYS License and Malpractice cert

AFFINITY HEALTH PLANS 6/2008 – 12/2013

CREDENTIALING SPECIALIST BRONX, NY

Performed Primary and secondary verification

Maintained Credentialing database (Cactus) tracking all new and existing providers

Collected all current paperwork for Cred. processing by fax, phone, mail and CAQH

Prepared and completed providers file / Credentialing and re-Cred for approval by Cred. Committee

BRONX LEBANON HOSPITAL –WINSTON AGENCY 12/2007 – 4/2008

CREDENTIALING REP. - MANAGE CARE DEPARTMENT BRONX, NY

Maintained and Monitored delegated providers

Completed and submitted providers application to Health plans for acceptance in network

BROWN BROTHERS HARRIMAN 12/2000 - 11/2006

COMPLIANCE ANALYST NEW YORK, NY

Updated restricted watch list and distributed monthly

Monitored records of all Trades executed by employees

Oxford Health Plans 12/1995 – 10/1999

CREDENTIALING / RE-CREDENTIALING REPRESENTATIVE WHITE PLAINS, NY

Maintained Providers file room

Performed Primary and secondary verification

Completed Medical Provider files for approval

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