Credentialing Coordinator

Writing a great credentialing coordinator resume is important because it is one of the first things a potential employer will see when they are considering you for a position. It is your opportunity to make a good first impression and sell yourself as the best candidate for the job.

Create your resume
Select from 7 professional resume templates

If you're looking for inspiration when it comes to drafting your own credentialing coordinator resume, look no further than the samples below. These resumes will help you highlight your experience and qualifications in the most effective way possible, giving you the best chance of landing the credentialing coordinator job you're after.

Resume samples

Gidget Quaschnick

gidget.quaschnick@gmail.com | (127) 797-4896 | Bismarck, ND

Summary


Over 1 year of experience as a Credentialing Coordinator. I have gained valuable knowledge in the medical field as well as excellent customer service skills. As a Credentialing Coordinator, I am responsible for ensuring that all providers are credentialed with insurance companies and up to date on their licenses/certifications. I have successfully completed numerous projects while working independently and keeping to strict deadlines.

Experience


Credentialing Coordinator at Sanford Health, NDJun 2022 - Present

  • Successfully completed 100% of all credentialing and re-credentialing applications for a network of 500+ providers in 15 states within the required 60-day timeframe.
  • Maintained high provider satisfaction ratings by completing 96% of all requests for information from providers within 24 hours.
  • Successfully negotiated contracts with 10 new hospitals, 5 new managed care organizations, and 20 new individual practitioners.
  • Created and implemented a streamlined process for primary source verification which reduced average turnaround time from 45 days to 30 days.
  • Established relationships with key contacts at state licensing boards, medical societies, and payer networks resulting in expedited processing of applications.
  • Collaborated with IT department to develop an automated tracking system for credentialing status which resulted in a 50% reduction in manual data entry.

Credentialing Specialist at Essentia Health, NDAug 2021 - May 2022

  • Streamlined the credentialing process, reducing the average time to complete by 15%.
  • Evaluated and updated provider files for compliance with insurance plans’ requirements.
  • Reviewed application materials and conducted primary source verification for over 500 new providers.
  • Onboarded 50 new hires in various medical disciplines including physicians, physician assistants, and nurse practitioners.
  • Monitors status of all active applications daily to ensure timely completion of privileging processes.
  • Conducts site visits as needed per accreditation standards.

Education


High School Diploma at Central High School, NDAug 2017 - May 2021

I've learned how to study for and take tests, how to do research, and how to write papers.

Skills


  • Medical Terminology
  • CPT & ICD-10 Coding
  • Data Entry
  • Microsoft Office Suite
  • Electronic Health Records (EHR) Systems
  • Insurance Verification & Authorization Procedures
  • Medical Billing & Reimbursement Processes

Laquaisha Konon

laquaisha.konon@gmail.com | (598) 850-4943 | Fairfax, Virginia

Summary


I have over 1 year of experience as a Credentialing Coordinator. I am responsible for the credentialing and recertification process for providers in our network. I maintain provider data in our internal database and coordinate with different departments to ensure that all required documents are received. I also verify provider credentials against primary sources such as state licensing boards, and national databases. In addition, I handle customer inquiries related to provider enrollment status updates.

Experience


Credentialing Coordinator at National Healthcareer Association, VAMay 2022 - Present

  • Spearheaded the development and implementation of a new credentialing system which resulted in a decrease in processing time from an average of 45 days to 20 days.
  • Successfully completed all site visits for JCAHO accreditation within 6 months while also maintaining compliance with NCQA standards.
  • Trained 4 new employees on proper procedures for credentialing providers according to state, federal, and company guidelines.
  • Reviewed and updated 300 provider files to ensure compliance with current requirements set forth by governing bodies.
  • Evaluated 10 privileging applications per month using established criteria and approved or denied accordingly following departmental policies & procedures.

Credentialing Specialist at American Medical Certification Association, VAJul 2021 - Apr 2022

  • Successfully completed the credentialing process for 100 providers in 4 months.
  • Successfully completed recredentialing process for 50 providers in 2 weeks.
  • Maintained a 95% provider enrollment rate throughout tenure.
  • Created and implemented new policies and procedures that resulted in a 10% decrease in time spent on each application.
  • Conducted training sessions for staff on proper use of credentials database, which resulted in more efficient data entry and retrieval times.

Education


High School Diploma at George Mason University, VASep 2016 - May 2021

I've learned how to read, write, and do math.

Skills


  • Medical Terminology
  • Coding
  • Data Entry
  • Microsoft Office Suite
  • Electronic Health Records (EHR) Systems
  • Medical Billing and Insurance Claims Processing