Customer Service Credentialing Specialist
Resume:
AMY PATRICK
*************@*****.***
Grand Prairie, TX 75050
Availability for Interview: Monday – Friday (Anytime) Summary:
● Excellent professional with experience in developing working knowledge of all credentialing aspects for designated CLM member accounts and served as a check and balance to ensure proper credential configuration for members within Optimizer.
● Proficient in using MDStaff, uploaded/pulled any credentials that were expired or expired updating the file to keep it current and compliant, updated certificate of insurance and applications.
● Well versed in operating routines, including policy and procedures, communication, and customer service and well with providers to reach goals they are obtaining.
● Skilled in many computer applications, including Microsoft Office, PowerPoint, MS Office Suite, and Excel, credentialing software Power BI, Echo, MDStaff, CAQH. Education: • Education Major, University of North Texas, 2006 – 2011 Experience:
Uber Driver, Dallas, TX Oct 2024 - Present
● Handled shop and delivers and delivered food to customers
● Drove customers to destination requested on Uber app Wheeler Staffing Partners, Inc. - Client Tenet Healthcare (contract), Dallas, TX May 2024 - Oct 2024 Senior Credentialing Specialist/Project Lead
● Maintained Arizona and California markets while leading the project.
● Trained new hires on projects.
● Filled out and updated applications for physicians.
● Input expired/expiring documents into MDStaff, ECHO, and CAQH.
● Lead on project: handled Arizona and California market.
● Enrolled physicians to various healthcare payers (Humana, Blue Cross Blue Shield, United Healthcare, Cigna, Centene etc.)
● Actively participate in team huddles and meetings.
● Primary Source Verification: boards, work history/employment history, licenses, certifications.
● Pulled expiring licences, DEAs, Certificate of Insurance and updated file in ECHO, MDStaff and CAQH.
● Created and modified Excel spreadsheets as needed for business needs. Vizient Inc./Vaya Workforce Solutions, Irving, TX
Credentialing Specialist/Associate Team Lead – Credentialing Feb 2019 - Mar 2024
● Maintain current workload while advising new accounts.
● Lead/Mentor/Guide a team. 1st layer of leadership for team members.
● In partnership with Management, maintains a close inspection of team metrics and bandwidth (as made evident through daily Workloads reports and regular communication).
● Conduct 1:1 meeting with team members to support immediate solutions to the work at hand and engage in meaningful conversations around long-term goals and development.
● Support Manager with succession planning (leadership bench) by identifying key talent and supporting growth in leadership competencies.
● Provide real-time feedback to team members daily and as needed; Send out team metrics (Team percent); Identify area of focus for that week (expiring, percent validated, etc.)
● Actively participate in team huddles and meetings.
● Promote a team atmosphere – understanding the motivators for each person on their team – providing a space where the team feels cohesive, engaged, and faces obstacles and challenges with a positive outlook. Being a model for how we want our team to act, behave and conduct themselves.
● Maintain positive relationships with internal partners and be the first layer of escalation for internal partners to reach out should someone on the team need coaching in this area. Help Address difficult agency questions/concerns.
● Learn software technology and troubleshoot any questions for Credentialing team
● Manage all daily credentialing needs which include validation of credentials for all newly hired contractors and providing clearance notifications to the Staffing Specialist.
● Lead Orientation Trainer for new hires in our CLM program
● Operate credentialing system Contract Labor Optimizer
● Develop working knowledge of all credentialing aspects for designated CLM member accounts.
● Serve as a check and balance to ensure proper credential configuration for members within Optimizer.
● Maintain internal and external positive relationships with nursing executives and healthcare staffing agencies.
Adeptus Health
Credentialing Specialist/Region Point of Contact Credentialing Lead, Irving, TX
● Brush and organize applications for providers Sep 2016 – Feb 2019
● Oversee small group of three as Point of Contact region lead for Arizona market
● Maintained and updated all credentials files as needed via Excel, and One App Pro
● Reviewed credentials files for potential red flags.
● Monitored and filed all received information.
● Recruited physicians to staff/credential with our facilities
● Turnaround Credentialing files from 18 days to 14
● Performed new applicant primary source verification.
● Updated One App Pro for currency and accuracy.
● Management of Salesforce system to log provider’s information
● Initiate responses to provider requests/needs
● Successfully completed quarterly Credentialing goals
● Documented and logged all pertinent documents on our system One App Pro
● Utilized provider relationships to aid in realizing the Company's vision.
● Identify network trends and gaps as it relates to provider questions and concerns
● Communicate any new or updated policy and/or procedure to providers
● Adheres to department operating routines, including policy and procedures, communication, and customer service
● Communicates well with providers to reach goals they are obtaining AMN Healthcare, Dallas, TX
Credentialing Analyst July 2015 - Sep 2016
● Utilize application system SBDev
● Input provider information to CAQH
● Involvement in brushing, and organizing applications for providers Provider/Client needs
● Initiate responses to provider requests/needs
● Documented and logged all pertinent communication including inquiries and concerns.
● Utilized provider relationships to aid in realizing the Company's vision.
● Identify network trends and gaps as it relates to provider questions and concerns
● Communicate any new or updated policy and/or procedure to providers
● Adheres to department operating routines, including policy and procedures, communication, and customer service
● Registered doctors in various insurance plans such as Medicare, Medicaid, Tricare Health Smart, Irving, TX
Provider Relations Coordinator/Credentialing Analyst/Mail Distribution July 2014 -July 2015
● Initiate responses to provider requests/needs
● Documented and logged all pertinent communication including inquiries and concerns
● Used systems CACTUS and CAQH
● Utilized provider relationships to aid in realizing the Company's vision.
● Identify network trends and gaps as it relates to provider questions and concerns
● Negotiate provider contracts as applicable
● Onboarded new members joining the network or renewing benefits
● Provide members with enrollment method options for PPO networks, pharmacy benefits and care management
● Communicate any new or updated policy and/or procedure to members
● Adheres to department operating routines, including policy and procedures, communication, and customer service
● Input, brush, and organize applications for providers joining network using CACTUS and CAQH software systems
● Dispense mail to various people throughout company
● Directs contracts to providers wanting to join network/nominations
● Communicates well with providers to reach goals they are obtaining Carlton Staffing: Client TA Hydronics, Dallas, TX
Marketing Coordinator/Event Coordinator March 2014 - April 2014
● Scheduled hotels, flights, and events for seminars that were out of town
● Event planning with companies in different states
● Performed a variety of routine typing assignments as appropriate to the position; may draft basic correspondence, enter data, and print letters, labels, reports, and/or other materials; creates and mails form letters.
● Copies materials as requested; sends facsimiles.
● Created expense reports when applicable
● Establishes, maintains, processes, and/or updates files, records, and other documents. Bunzl & R3 Dallas, Dallas, TX
Receptionist: General Office Assistant/Mail Clerk/Invoice Credits Scanner Aug 2013 -May 2014
● Answers telephones, routed calls, takes messages, and provides general information; greets and directs visitors; answers routine inquiries.
● Opens and routes incoming mail; distributes correspondence and other material to appropriate people.
● Performs a variety of routine typing assignments as appropriate to the position; may draft basic correspondence, enter data, and print letters, labels, reports, and/or other materials; creates and mails form letters.
● Copies materials as requested; sends facsimiles.
● Establishes, maintains, processes, and/or updates files, records, and other documents. Sam Houston Middle School, Irving, TX
Paraprofessional: Special Education Aide/Permanent Sub/Administrative Aide Jan 2011 - June 2013
● Communicated with parents and staff both verbally and electronically
● Answered and quickly redirected more than 50 calls per 9-hour period.
● Greeted numerous visitors, including parents, administration building employees, vendors, and interview candidates.
● Maintained a clean reception area, including lounge and associated areas.
● Screened all visitors and directed them to the correct employee or office. Irving Independent School District, Irving, TX
Substitute Teacher/Long Term Substitute Jan 2005 - June 2011
● Implemented lesson plans left by classroom teacher 1/05-6/11
● Motivated and engaged students in preparation for various tests by the state of Texas
● Graded tests and papers on behalf of classroom teacher
● Recorded grades per the classroom teacher.
John R. Good and Sam Houston QUEST After School Achievement Program, Irving, TX Teacher and Receptionist Jan 2005 - May 2010
● Instructed students in computer technology, reading, and physical education
● Directed students to their appropriate destinations
● Helped the students stay motivated and interested in learning
● Executed and delivered various calls to teachers from parents using a multi-line phone system Volunteer & Extracurricular Activities:
● Assisted special needs students at Irving Intervention Center.
● Conducted activities for campus family nights and heritage events.
● Managed Jazzercise classes at Lee Park Recreation Center.
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