SaKita M. Rudolph

*** ****** ** *** ** Sharon Hill, PA 19079 H: 610-***-**** C: 267-***-**** ac7xs5@r.postjobfree.com

SUMMARY

Finely tuned analytical skills with a dedication to expanding subject knowledge and workplace competencies through continuing research and training. Experienced in navigating teams through changing business environments; willingly assume extra responsibility to ensure optimal and timely project execution.

WORK HISTORY

Credentialing Coordinator, Corporate Credentialing

Provider Data Management SME, Corporate Provider Data Management

SKILLS

Visual Cactus, Primary Source Verification, CAQH, CredSimple, Extensive Medical Terminology, Enclarity, Optum, Exclusion Check (Provider Trust), Talent Wise, OIG, Medicare Opt-Out

Facets, Provider Automation, SIR, EXP, NPPES, Invalid Provider Queue, Contract Manager, PRIMA, Proficient with Microsoft Word, PowerPoint, Excel and Access, NPDB, PROMISe, Medicaid Verification

EXPERIENCE

01/2017 to 10/2018 Credentialing Technician/Coordinator

AmeriHealth Caritas Family of Companies – Philadelphia, PA

Review of practitioner and provider applications for completeness. Notify applicant of any missing or expired information. Accurately enter provider data into Visual Cactus for credentialing within the established turnaround times; Document completion of recredentialing process in the system. Monitor, respond to, and direct all request from the Credentialing Inbox. Send approval letters to providers upon completion of the credentialing process.

03/2008 to 1/2017 Provider Data Management Senior Technician (SME)

AmeriHealth Caritas Family of Companies – Philadelphia, PA

Implement and plan for all new Lines of Business, as it pertains to Provider Data and claims payment. Traveling to coordinate and acclimate all internal associates for each individual plan. Add, modify or delete Facilities, (Providers), Provider Groups and practitioners in Facets while using Visual Cactus to determine the provider’s status. Other applications were utilized to verify information, Identify and resolve provider data errors, allowing claims to be manually adjudicated. Major contributor to the development and maintenance of Online Help. Conducted training for AHCI Facets and EXP. Chosen to assist with rectifying PDMs portion of the Iowa CAP

11/2007 to 03/2008 Administrative Assistant

REO Elite Abstract, Inc -Philadelphia, PA

Received all incoming calls, on and off duty. Performed Title searches for New Jersey and Pennsylvania residential. Draw up and record deeds for mortgages. Recorded meeting minutes

References available at your request

EDUCATION

1994 to 1996 Florida A&M University, Tallahassee FL

Major: Chemistry

2001 to 2003 Miami Dade College, Miami FL

Allied Health Diploma; Associates degree