Management Staff Credentialing Specialist
Resume:
MARIE LAWSON
(h) 954-***-****, (c ) 954-***-****
Email: ad1irz@r.postjobfree.com
SUMMARY: A broadly experienced professional with recognized achievements and 14 years of credentialing experience working in a corporate and healthcare office environment. Possess exceptional communication skills. Very detail-oriented with the ability to work under extreme pressure to meet strict deadlines.
PROFESSIONAL EXPERIENCE
MCNA Dental - Ft. Lauderdale, FL 11/2019-08/2023
Credentialing Specialist
Process applications on behalf of new and existing providers as needed.
Complete all necessary and appropriate forms for PSV and file in preparation of Credentialing Committee review.
Collect and maintain files in relation to credentialing of network agencies and providers including applications, contracts, current state licenses, accreditation, malpractice insurances and other pertinent forms.
Escalate all issues to the appropriate members of the management staff, region, and/or co-workers as necessary.
CAQH – Downloaded CAQH application for credentialing and re-credentialing applications for providers.
Sunshine Health - Sunrise, FL 10/2013-09/2019
Credentialing Specialist
Process applications on behalf of new and existing providers as needed.
Complete all necessary and appropriate forms for PSV and file in preparation of Credentialing Committee review.
Collect and maintain files in relation to credentialing of network agencies and providers including applications, contracts, current state licenses, accreditation, site inspections, malpractice insurances and other pertinent forms.
Escalate all issues to the appropriate members of the management staff, region, and/or co-workers as necessary.
Healthcare Support Staffing, Inc.- Winter Park, FL 11/2012-10/2013
Credentialing Coordinator
Process applications on behalf of new and existing providers as needed.
Complete all necessary and appropriate forms for PSV and file in preparation of Credentialing Committee review.
Collect and maintain files in relation to credentialing of network agencies and providers including applications, contracts, current state licenses, accreditation, site inspections, malpractice insurances and other pertinent forms.
Escalate all issues to the appropriate members of the management staff, region, and/or co-workers as necessary.
Converting paper files to electronic files.
Career Xchange - Pembroke Pines, FL 05/2012-11/2012
Credentialing Coordinator
Process applications on behalf of new and existing providers as needed.
Complete all necessary and appropriate forms for PSV and file in preparation of Credentialing Committee review.
Collect and maintain files in relation to credentialing of network agencies, including applications, contracts, current state licenses, accreditation, malpractice insurances and other pertinent forms.
Escalate all issues to the appropriate members of the management staff, region, and/or co-workers as necessary.
Hospital Physician Partners - Hollywood, FL 09/2008-03/2012
Credentialing Coordinator
Process applications to obtain licenses and hospital privileges on behalf of new and existing providers as needed. Generate and send verification letters needed for licensure.
Complete all necessary and appropriate forms for PSV and file in preparation of Credentialing Committee review.
Maintain and update database with status and necessary data elements. Document all tasks, phone calls, emails and other forms of communication during the credentialing and re-credentialing process in the database. Conduct written and oral follow up to determine application status.
Respond promptly to all questions, received via phone or email, regarding any license and/or privilege.
Communicate with all necessary internal departments as needed. Scan and index completed applications. Develop and maintain relationships with staff at the individual boards and hospitals.
Participate in the delegated credentialing audit process as needed. Complete other tasks or projects as assigned.
Provider Enrollment – Completed Physician, NP and PA credentialing application and submit to the health plans such as Aetna, Blue Cross BlueShield, Cigna and Humana to have the providers credentialed.
EDUCATION:
Associate Degree in Business Administration 05/2010 to 05/2013
Broward College, Pembroke Pines, FL
Bachelor Degree in Health Services 11/2013 - 05/05/2017
Florida Atlantic University, Boca Raton, FL
COMPUTER SKILLS
MS Word, Excel, E-Money, Physician Manager, Patient Manager, Infonet, Staffing Angels, Portico and Dentaltrac.
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