Credentialing Specialist Provider Enrollment

Penny L. Williams

601-***-**** *************@*****.*** Loganville, GA

Provider Enrollment Specialist

Managed Care Enrollment \ Hospital Affiliation \ Primary Source Verification

Highly skilled Credentialing Specialist with proven expertise in hospital affiliation and revalidation applications. Monitoring medical license and DEA certification renewals. Excellent communication, team building and problem-solving skills. Adept in web-based research operating credentialing software. Acknowledged for outstanding performance with HRSA audits and community service participation.

Experience

Credentialing Specialist September 2018 – present

Georgia Nephrology

Ensure the completion of enrollment applications through Health Plan websites and excel rosters.

Prepare and submit initial and revalidation hospital affiliation requests.

Verify the completeness and accuracy of company and provider directory information on Health Plan Portals.

Track and monitor timely renewal of state medical licensures and DEA certifications.

Assist in the resolution of payer denial issues.

Initiate completion and submission of mid-level protocol agreements to state board.

Conduct primary source verification for all licensed providers.

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Provider Enrollment Coordinator (Part time) September 2021- September 2023

ALN Medical Management

Ensure accurate and timely entry of provider information into enrollment databases such as PECOS, NPDB and CAQH.

Review enrollment application for completion and accuracy

Research license compliance updates

Confirm provider network participation and effective dates.

Credentialing Specialist January 2005 – September 2018

Central Mississippi Health Services

Present comprehensive credentialing files during monthly board meetings, ensuring the thorough review and approval of candidate qualifications.

Facilitate quarterly in-service departmental trainings.

Initiate provider onboarding and insurance network participation.

Ensure annual review of credentialing policies and procedures.

Acquire and manage confidential documents for credentialing files.

Education

M.S. Human Resource Management University of Phoenix

B.A. Counseling Jackson State University

A.A. Social Work/Sociology Holmes Community College

Acknowledgments

Recognized for exceptional performance during six consecutive HRSA audits.

Completed comprehensive training in Cultural Diversity, enhancing cross-cultural communication and understanding.

Completed rigorous project management training, acquiring skills in planning, execution, and monitoring of projects.

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