Credentialing Specialist and Compliance Coordinator

Alexandra M. Tai

Credentialing Specialist

*********@*****.*** Phoenix, 85339, United States 808-***-**** Summary

Dedicated Credentialing Coordinator with over 7 years of experience ensuring provider compliance and data integrity within healthcare organizations. Proven ability to manage critical provider files, conduct primary source verification, and navigate complex databases like CAQH and Javelina. Skilled in auditing, regulatory compliance, and maintaining alignment with accreditation standards. Eager to contribute expertise in provider enrollment and meticulous data entry to support Total Life Inc.'s mission of delivering quality care. Work Experience

Lead Provider Credentialing Coordinator, Hawaii Western Management Group, Remote 08/2025 – 06/2026

Spearheaded the auditing and management of critical provider files, employing primary source verification to ensure absolute data integrity and regulatory compliance. Served as the senior point of contact, navigating complex database systems daily, including CAQH, Javelina, and FACTS software to track and report network status updates. Orchestrated daily collaboration via Microsoft Teams to coordinate across internal departments, lead virtual huddles, and maintain seamless operations in a remote environment.

Provider Credentialing Coordinator, Hawaii Western Management Group, Remote 09/2018 – 08/2025

Conducted rigorous, ongoing monitoring of licenses, certifications, and health network participation status to actively mitigate organizational risk. Investigated and thoroughly documented adverse incidents involving participating providers, ensuring swift and diplomatic resolution in accordance with company policies. Maintained strict alignment with health network accreditation standards and internal corporate guidelines under independent, remote working conditions. Communications Coordinator, Hawaii Western Management Group, Honolulu 05/2011 – 09/2018

Initiated communication and marketing materials, including event/trade show collateral, while providing accurate information and meeting deadlines. Served as a liaison between department managers, assisting with the collection, review, and distribution of data and reports to improve operational efficiency and accuracy in communications.

Addressed complex inquiries as the primary point of contact, resolving customer issues efficiently while maintaining an exceptional level of service under tight timelines. Demonstrated consistent performance and organizational dedication, resulting in a formal promotion into the remote network credentialing division. Education

Diploma, High School, Kaiser High, Honolulu, HI

Skills

CAQH (Credentialing Database) Microsoft Teams

Javelina (Proprietary Insurance Software) FACTS Microsoft Excel Microsoft Word Data Entry Primary Source Verification Quality Assurance Regulatory Compliance Auditing File Management Daily Virtual Collaboration Independent Troubleshooting Time Management HighVolume Workflow Customer Support Medicare Guidelines