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Centene Corporation - Credentialing Specialist Resume Example

Alexander Wilson
XXXXX XXXXXXXX XXXXX, Saint Louis, MO 63136 | (H) XXXXXXXXXXXX | XXXXXXXXXXXXXXXXXXXXXXXX
Summary
I am seeking to obtain a position within a progressive company allowing for personal and professional growth. My combined professional experience within the healthcare industry includes an emphasis in credentialing, quality management, health information management and education/training. My strong and numerous computer skill-sets have given me the ability to succeed in many facets of the healthcare industry.
Skills and Abilities

Word, Excel, Outlook, Access, Windows Version -/2000/ XP/20003-2007/2010, excellent customer skills, ability to learn through observation and hands on experience, ability to follow routine vertical and written instructions, ability to effectively communicate with co-workers and customers, Medical terminology; Managed Care; Medical Staff Services;  Medicare/Medicaid; Federal and State statues and laws; Hospitals/Home Health; HIPAA; Provider Relations; Process Improvement; Data Analysis; The Joint Commission, OSHA, NCQA, URAC Accreditations.

Experience
Credentialing Specialist 03/2014 to Present
Centene Corporation Chesterfield, Mo
Manage primary source verification of new applicants. Maintains accurate updated Portico database. Imparted quality oversight and analysis of the Physician and Mid Levels Credentialing Files   
Medical Staff Coordinator 12/2013 to 03/2014
Mercy Hospital, SSM Healthcare System Creve Coeur, Mo.
  • Consult with director and offer administrative support for hearing committees; Draft correspondence assuring compliance with bylaws, rules and regulations; Collaborate GME and CME functions; Liaise between medical staff and administration and communicate sensitive issues; Interface with internal and external customers; Judge and met discretion for peer review protection to hospital and medical staff; Finish and ensure credentialing process accuracy; Request information from external medical; Prepare, disseminate and maintain physicians emergency department call schedules; Oversee Medical Staff Services function.
Lead Credentialing Specialist 12/2012 to 12/2013
Centene Corporation-Corporate Office Clayton, Mo
  • Promoted to current position; Developed of a totally paperless credentialing system; Amenable for the development, revision and institution of the Policy and procedures; Facility and Organizational files and reports; Facilitated and organized bi-weekly credentialing committee meetings for all major legal discrepancy and medical review; Verified information from the provider's malpractice insurer, state license and education/training; Staff trainings, productivity tracking, quality control and files auditing; Oversee all credentialing files for quality control prior to committee review and approval; Review all legal discrepancy findings through the National Practitioner Data Bank (NPDB/HIPB); Improved current departmental processes for initial and re-credentialing turnaround time frames; Outreach to providers to ensure their timely renewal of expiring licenses and certifications; Credential and re-credential all Nurse Practitioners and Physicians applications in accordance with The Joint Commission Provider C.
Credentialing Specialist 01/2009 to 12/2012
Centene Corporation-Corporate Office Clayton, Mo.
  • Mail Merger; Monthly Sanction Reports and Logs; Facility and Organizational files and reports; Facilitated and organized bi-weekly credentialing committee meetings for all major legal discrepancy and medical review; Verified information from the provider's malpractice insurer, state license and education/training; Staff trainings, productivity tracking, quality control and files auditing; Oversee all credentialing files for quality control prior to committee review and approval; Review all legal discrepancy findings through the National Practitioner Data Bank (NPDB/HIPB); Improved current departmental processes for initial and re-credentialing turnaround time frames; Outreach to providers to ensure their timely renewal of expiring licenses and certifications; Credential and re-credential all Nurse Practitioners and Physicians applications in accordance with The Joint Commission Provider Credentialing Program/NCQA Standards.
Senior Credentialing Coordinator 03/2008 to 11/2009
Spectrum Healthcare Resources-Corporate Office Creve Coeur, Mo.
  • Promoted to current position; Functioned as subject matter expert for all credentialing inquires, processes, policies and procedures; Responsible for all new Credentialing Coordinator training; Ability to accept new projects and assignments as they become necessitated.
Credentialing Coordinator 03/2006 to 03/2008
Spectrum Healthcare Resources-Corporate Office Creve Coeur, Mo.
  • Compile/ process provider and employee credentialing applications in compliance with federal, state, managed care, and regional requirements; Respond to provider inquiries received by letter, phone, or internal departments; Collaborates with recruiter/employment specialists to monitor the recruitment status of provider and employee staff candidates to ensure timely credentialing prior to employment; Reviewed and ensured credentials of all provider files met the Joint Commission Accreditation standards.
Senior Health Information Management Clerk 04/2002 to 03/2006
Forest Park Hospital-Tenet Healthcare System St. Louis, Mo.
  • Promoted to current position; Employee of the Month 2x (July/September); Effectively and productively trained new hire, Health Information Clerks; Conduct bi-weekly audits; Decreased delinquent records by 52%; Assist and/ or notify physicians in completion of Inpatient/Outpatient medical records; Assist RN Case Managers in obtaining medical records, off-site in a timely manner; Filing and editing of dictated transcription reports; Assemble and analyze confidential medical records.
  • Employee of the Month (Department); Maintained confidential Inpatient/Outpatient Medical Records; Managed data entry; Multitasking.
Health Information Clerk 04/2001 to 04/2002
Forest Park Hospital-Tenet Healthcare System St. Louis, Mo.
  • Protect the security of medical records to ensure that confidentiality is maintained; Review records for completeness, accuracy, and compliance with regulations; Retrieve patient medical records for physicians, technicians, or other medical personnel; Release information to persons or agencies according to regulations; Compile and maintain patients' medical records to document condition and treatment and to provide data for research or cost control and care improvement efforts.
Pharmacy Clerk 11/2000 to 02/2001
Barnes-Jewish Hospital-BJC Healthcare System St. Louis, Mo
  • Entered pharmacy billing charges; Insured accuracy of prescription information; Answered multi-telephone Lines.
Education
Associate of Science: Some College Coursework Florissant Valley Community College - Florissant, Mo
Medical Assistant: Some College Coursework Missouri College - Kirkwood, Mo
Associate of Science: Business Administration Columbia College - Woodson Terrace, Mo.
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Resume Details

This is a real resume for a Credentialing Specialist in Saint Louis, Missouri with experience working for such companies as Centene Corporation, Mercy Hospital, Ssm Healthcare System. This is one of the hundreds of Credentialing Specialist resumes available on our site for free. Use these resumes as templates to get help creating the best Credentialing Specialist resume.

Previous Companies:

  • Centene Corporation
  • Mercy Hospital
  • SSM Healthcare System

Previous Job Positions:

  • Credentialing Specialist
  • Medical Staff Coordinator
  • Lead Credentialing Specialist
  • Senior Credentialing Coordinator
  • Credentialing Coordinator

Schools:

  • Florissant Valley Community College
  • Missouri College
  • Columbia College

Level of Education:

  • Associate of Science
  • Medical Assistant

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