A Credentialing Analyst works for the healthcare organization and makes sure that the physicians and the facility comply with relevant regulations. The job duties associated with this role are listed on the Credentialing Analyst Resume are – maintaining records relating to insurance contracts and on staff credentials; keeping in touch with staff and insurance companies to ensure that all necessary documents are maintained; informing about changes in contracts and policies; preparing and maintaining reports of credentialing activities; making sure all information meets federal and state guidelines while processing applications; maintaining all records and documenting application and verifying the same. The description also includes keeping up to date and the facility’s accreditation and assisting auditors.
Apart from possessing a degree in health information management, the analysts are expected to embrace the following skills as well- familiarity with NCQA standards; proficiency with computer systems, network and software applications; and prior work experience.
Objective : Credentialing Analyst professional with experience coordinating and completing the credentialing process for medical providers. Proven ability to build solid professional relationships, provide excellent customer service, and communicate fluently in five languages.
Skills : Customer Service, Administrative Assistant, Good Communication Skills.
Description :
Coordinated and participated in the credentialing/re-credentialing process.
Performed required credentialing/re-credentialing reviews and/or evaluations.
Maintained high production and quality factors.
Created and implemented desktop/operational procedures for the credentialing/re-credentialing process.
Identified improvement opportunities and recommended enhancements and workable solutions.
Provided telephonic education to providers on credentialing/re-credentialing policies and procedures.
Identified and communicated trends (quality of results, efficiencies of processes).
Experience
2-5 Years
Level
Executive
Education
GED
Credentialing Analyst Resume
Objective : Highly motivated Credentialing Analyst with extensive experience in the health care industry. Possesses a thorough knowledge of NCQA and JCAHO guidelines, policies, and procedures. Accomplished in collecting, analyzing, researching, and compiling data using current technology to ensure a high-quality physician network. Keen problem-solving ability and memory for detail.
Skills : Microsoft Office, Managing Skills, Directing Skills.
Description :
Participated in the development of credentialing processes and workflows.
Identified improvement opportunities and recommends enhancements and workable solutions.
Provided telephonic education to providers/producers on credentialing policies and procedures.
Researched and prepared risk-sensitive or complex business review/credentialing verification items for CPC.
Directly contracted providers/producers and/or outside entities to clarify data quality issues.
Acted as a liaison with hospitals, other affiliated organizations, and managed care organizations regarding issues pertaining to managed care and credentialing.
Experience
2-5 Years
Level
Executive
Education
BS In Business Administration
Credentialing Analyst Resume
Objective : As a Credentialing Analyst, responsible for Preparing Provider Enrollment forms, hard copy or electronically, as required by payors, and also updating the CAQH website with current required provider information as needed.
Skills : Store Management, Compliance, Inventory Management, Customer Service.
Description :
Used of multiple computer applications (CCQAS, CAQH, and Anthem) for preparation of files for Credentialing Certification Board for Approval in order to be approved for Privileging at Medical Facilities.
Reviewed of Practitioner credentialing file for missing information.
Obtained verification of practitioners' credentials (all medical licensure) by a primary source, internet, and clearinghouses.
Obtained Malpractice Insurance Certificates and NPDP-HIPDB self-queries.
Coordinated file review and approval by Manager and Medical Directors, as required.
Coordinated and assisted with hospital/clinic, medical staff office, and practitioners to complete the privileging process at the designated facility.
Coordinated the sharing, receipt, and/or update of information among various internal departments and other regions, if requested.
Experience
2-5 Years
Level
Executive
Education
GED
Credentialing Analyst Resume
Objective : To secure a full-time Credentialing Analyst position with your company that will utilize my credentialing and customer service experience, and to enable me to make a positive contribution to your organization and continue my quest to learn.
Skills : MS Office, Researching Skills, Customer Service.
Description :
Researched, gathered, analyzed, and ensured the accuracy of providers Credential/Recredential data for providers in all BCBSI managed care networks.
Met and exceeded the National Committee for Quality Assurance (NCQA) and corporate guidelines by adhering to (NCQA) policy.
Retrieved providers credentialing applications from Credential Smart Database and Primary Source.
Verified all required documents including provider's references.
Requested missing elements and mailed delineation of privileges to providers.
Updated physician's current demographic information using the VisStar database.
Communicated with the Provider Selection Committee (Medical Management Department) through the presentation of providers who are eligible for designation into a BCBSIL network.
Interacted with Networks and other departments to discuss product needs and concerns for providers via e-mails and phone calls.
Experience
2-5 Years
Level
Executive
Education
GED
Credentialing Analyst Resume
Objective : Seeking a Credentialing Analyst profession with an outstanding career opportunity that will offer a rewarding work environment along with a winning team that will fully utilize management skills.
Skills : MS Office, Analyst, Organizational Skills.
Description :
Maintained a positive relationship with providers by providing general product information relative to PPO/POS/HMOI contracts and status.
Provided issue resolution for providers/producers, during the credentialing or data management processes.
Responded to network or provider/producer inquiries, including contracting and credentialing policy, procedures, credentialing status.
Researched and prepared risk-sensitive or complex business reviews/credentialing verification items for PSV vendors.
Provided ongoing support to department members in completing research and analysis to resolve complex issues raised by providers and/or other internal/external customers.
Interfaced with internal and external customers in matters pertaining to physician credentialing applications and forms.
Worked closely with billing on payer enrollment issues and in resolving discrepancies in billing statements related to physician credentialing and enrollment.
Experience
2-5 Years
Level
Executive
Education
High School Diploma
Credentialing Analyst Resume
Objective : Credentialing Analyst with 5 years of experience in Maintaining confidential files of all Allied Health Professionals. Consistently driven to go above and beyond expectations using effective leadership skills to accomplish goals.
Coordinated the Credentialing Department process with the Member Records Department by administering the process of receiving, tracking, reviewing, and entering all applications for NASW Credentialing Department products .
Performed various administrative tasks in support of Continuing Education programs for the Credentials office.
Worked with the IT department, I updated internal and external Continuing Education (CE) information sources as needed and advised.
Responsible for updating and maintaining CE databases, records, and filing systems.
Collaborated with new hospital clients and establish processes to facilitate onboarding for new hires by a strict deadline.
Generated and delivered onboarding process reports for hospital management by providing status updates on new hires.
Facilitated credentialing related training.
Experience
2-5 Years
Level
Junior
Education
Bachelor Degree
Credentialing Analyst Resume
Headline : Highly skilled Credentialing Analyst, responsible for providing consultation to Prisma Health UMG AHP providers for enrollment with Delegated Managed Care contracts with regard to the application and reapplication process.
Skills : Microsoft Office, Coordinating Skills, Planning Skills.
Description :
Directed communication with the healthcare professional on missing or expiring compliance requirements.
Monitored the progress on expiring documents, communicates current status to facilities, and negotiates compliance, as necessary.
Worked as a liaison between the Operations Department and the Sales Team to address all outstanding operational issues.
Communicated directly with internal and external customers to ensure all requirements are completed accurately and timely, providing excellent customer service to all internal and external parties.
Coordinated aspects of drug screen testing, criminal background checks according to facility requirements.
Gathered and documented facility requirements and assisting healthcare professionals in obtaining necessary requirements to ensure assignment start dates are met.
Performed primary source verification of provider credentials, education, and employment history.
Experience
5-7 Years
Level
Executive
Education
BS
Credentialing Analyst Resume
Headline : As a Credentialing Analyst, responsible for Providing consultation to Prisma Health UMG provider Allied Health Professionals for clinical privileges with regard to the application and reapplication process.
Skills : Microsoft Outlook, Researching Skills, Team Work.
Description :
Oversaw and coordinated all aspects of credentialing for provider groups and facilities applying to become participating with a large Managed Care Organization.
Prepared monthly agenda and Credentialing Committee meeting minutes.
Responsible to maintain compliance with accreditation and regulatory bodies (URAC and EQRO).
Reviewed and updated policies and procedures to enhance and streamline the credentialing process.
Collaborated with Contract Specialists in establishing Best Practices for Network Management Team.
Conducted Delegation Oversight including desktop and onsite audits.
Created training materials for Provider Relations Representatives.
Experience
5-7 Years
Level
Executive
Education
Master Of Degree
Credentialing Analyst Resume
Headline : Seeking a Credentialing Analyst. 2 years of experience in collaborating with the manager, serves as a coach and a resource to guide research and to support quality performance as needed.
Skills : Powerpoint, Customer Service, Team Player, Attention To Detail, Bilingual, Data Entry.
Description :
Compiled, maintained, and distributed detailed project activities necessary to meet project reporting and evaluation.
Compiled weekly and monthly status reports for executives.
Responsible for achieving full compliance for healthcare professionals in a timely manner prior to and throughout their assignments.
Assessed healthcare professional credentials for deficiencies to standard and communicates to production when a healthcare professional cannot be accepted.
Communicated expiring documents to the assigned Recruiter and assisted as necessary to ensure that updated documentation is collected.
Coordinated aspects of drug screen testing, criminal background checks, and case logs according to site credentialing requirements.
Provided feedback to the billing department regarding financial and/or operational issues with payers.
Experience
5-7 Years
Level
Junior
Education
Bachelor Degree
Credentialing Analyst Resume
Objective : As a Credentialing Analyst, responsible for collaborating with the manager. To provide and/or support professional development for junior staff, and serves as the lead person for keeping abreast of knowledge and developments in the field.
Skills : Good Communication Skills, Multitasking, Interpersonal Skills.
Description :
Performed initial quality assurance function by reviewing/analyzing incoming documentation for accuracy and completeness.
Initiated translation of foreign language documents as required.
Followed up with primary sources and physicians if documentation is delinquent.
Oversaw the credentialing/re-credentialing process of company providers.
Coordinated the provider application and contracting process to ensure efficiency.
Facilitated the application enrollment process of all newly signed and existing practice sites with specific government or private carriers.
Assisted with the site credentialing process including gathering and documenting facility requirements and assisting healthcare professionals in obtaining necessary requirements to ensure assignment start dates are met.
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