Credentialing Specialist Provider Enrollment
Resume:
Arianna Stout
**** ****** ***** **** ***. #****, Euless, TX
ad5slv@r.postjobfree.com
Dedicated and detail-oriented Credentialing Specialist with over 3 years of experience in Healthcare Credentialing processes. Skilled in verifying healthcare provider credentials, managing databases, and ensuring compliance with regulatory standards. Proficient in maintaining accurate and up-to-date credentialing files, facilitating provider enrollment, and resolving credentialing issues efficiently. Adept at collaborating with internal teams and external stakeholders to streamline processes and optimize credentialing workflows. Strong organizational and communication abilities, with a proven track record of ensuring provider qualifications meet industry standards. Professional Experience
Credentialing Specialist
River Region Psychiatry Associates, Montgomery, AL September 2023 - May 2024 Compliance Specialst
Supplemental Healthcare, Dallas, TX February 2023 - August 2023 Credentialing Specialist
Healthcare Highways, Frisco, TX September 2022 - February 2023 Credentialing Administrator
Pacific Dental Services, Irving, TX May 2021 - September 2022 Conducted thorough credential verification and background checks for healthcare practitioners in compliance with industry regulations
Oversaw the maintenance of credentialing files, ensuring accuracy and completeness of documentation Collaborated with internal teams and external providers to resolve credentialing issues and discrepancies in a timely manner
Regularly reviewed and updated credentialing policies and procedures to maintain compliance with accreditation standards
Demonstrated ability to streamline processes and improve efficiency within organizational structures Demonstrated ability to efficiently prioritize tasks to meet deadlines and achieve project goals Proficient in creating and maintaining organized filing systems for easy access to important documents Conducted thorough assessments of company policies and procedures to ensure compliance with industry regulations and standards.
Monitored and investigated potential compliance violations, taking corrective actions to mitigate risks and prevent further non-compliance issues.
Collaborated with cross-functional teams to proactively address compliance concerns and implement solutions to promote a culture of compliance within the organization. Prepared and submitted regulatory reports and documentation in a timely manner, demonstrating attention to detail and accuracy in compliance-related tasks.
Address credentialing requests, overseeing compliance with governmental and organizational guidelices
(NCQA/JCC) regarding tiered data access.
Processed documents and status-change requests, conducting follow up assessment regarding enrollment inquiries. Organized records to prepare for site visits by Credentialing Representativies and associated audits. Tagged documents according to tiered access thresholds, updating packets, reviewing reports and forwarding items requiring approval or verficiation.
Maintained informational resources, tracking and documenting requires for updates, certification and credentialing.
Processed and maintained accurate documentation of dental providers' credentials, licensure, and certifications in compliance with industry standards and regulations Updated and monitored credentialing databases and systems to track provider credentials, expiration dates, and compliance status to ensure timely renewals and updates Managed the enrollment process for dental providers with insurance plans by completing applications, submitting required documentation, and resolving any issues that arose Medical Appeals Processor
Advanced Reimbursement Solutions, Scottsdale, AZ June 2020 - May 2021 Data Entry Specialist
Kroger Law Group, CA September 2019 - April 2020
Education
BA in Psychology August 2016 - December 2020
University of Arizona at Tucson, AZ
Minor in Sociology
Key Skills
Reviewed and processed complex medical appeals in accordance with insurance guidelines and regulations Communicated effectively with healthcare providers, insurance companies, and patients to gather necessary information for appeal cases
Maintained accurate and detailed records of appeal cases, ensuring compliance with HIPAA regulations and confidentiality protocols
Collaborated with cross-functional teams to streamline appeal processes and improve overall efficiency in handling medical appeals
Conducted in-depth research and analysis to identify and resolve appeal discrepancies, resulting in a high rate of successful appeals
Utilized electronic case management systems to accurately input and update court date information Organize and prioritize incoming tickets to ensure prompt entry and processing Efficiently input hundreds of traffic tickets from California residents into the company system on a daily basis Responded to inquiries from citizens through various communication channels, including phone calls and emails Maintained accurate records of interactions with citizens and updated information in the case management system Microsoft Office (Excel, Word, Power Point)
Organization
Customer Service
Teams, Ring Central, Zoom, Echo, Modio
Licensing Regulations
Provider Enrollment
Initial/Reappointment Credentialing Applications
Process Implementation
Database Management
Quality Control
Application Management
Detail Oriented
Privacy and Confidentiality (HIPAA)
Commercial Insurance
Critical Thinking
Onboarding/Training
PSV/CAQH/NPPES
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