Medical Specialist
Resume:
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
Contact this candidate