Credentialing Specialist

Writing a great credentialing specialist 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.

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If you're looking for inspiration when it comes to drafting your own credentialing specialist 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 specialist job you're after.

Resume samples

Louann Keuper

louann.keuper@gmail.com | (468) 537-7475 | Omaha, NE

Summary


I am a credentialing specialist with over 1 year of experience working in the medical field. I have experience working with insurance companies and hospitals to obtain credentials for providers. I am familiar with JCAHO, NCQA, and CMS standards. I also have experience maintaining provider databases and tracking Continuing Medical Education (CME) credits.

Experience


Credentialing Specialist at Blue Cross Blue Shield, NEMar 2022 - Present

  • Successfully credentialed 100% of new providers within 30 days of joining the organization.
  • Maintained a 95% provider re-credentialing success rate.
  • Successfully completed 5 site visits per month with an average score of 97.5%.
  • Worked collaboratively with internal and external customers to resolve issues in a timely manner.
  • Demonstrated excellent customer service skills by exceeding patient satisfaction scores by 5 points for 3 consecutive months.
  • Achieved departmental goals related to cost containment, productivity, and quality.

Credentialing Specialist II at Aetna, NESep 2021 - Jan 2022

  • Authored and updated credentialing applications for over 500 providers.
  • Led the development of a new provider onboarding program which reduced time to full privileging by 30%.
  • Chaired monthly meetings with department heads to ensure compliance with all regulatory agencies.
  • Monitored status of license renewals, malpractice insurance and DEA certifications for 2000+ providers.
  • Reviewed completed Provider Credentialing Packets prior to submission to Board office.
  • Successfully completed site visits for CAQH, NCQA, Joint Commission and other health plans as needed.

Education


Associate of Arts in Business Administration at Bellevue University, NEAug 2017 - May 2021

I have learned how to manage my time efficiently, how to work in a team, and how to communicate effectively with others.

Skills


  • Medical Terminology
  • Coding and Billing
  • Insurance Verification
  • Medical Records Management
  • Provider Enrollment
  • Contract Review and Negotiation
  • Ability to work in a fast paced environment

Saba Santander

saba.santander@gmail.com | (289) 073-4902 | Kailua, HI

Summary


I am a credentialing specialist with over 1 year of experience. I have worked in various healthcare settings and have gained a strong understanding of the credentialing process. I am well-versed in both primary source verification and secondary sources, and have successfully completed numerous projects from start to finish. My attention to detail ensures that all credentials are accurate and up-to-date, while my excellent organizational skills keep track of deadlines and ensure timely submissions. Above all, I pride myself on being a team player who is always willing to lend a helping hand – no matter how big or small the task may be.

Experience


Credentialing Specialist at American Medical Association (AMA), HIMar 2022 - Present

  • Led a team of 5 in-house credentialing specialists and processed an average of 500 applications per month.
  • Successfully completed 99% of all tasks assigned within the established timeframes.
  • Trained 2 new employees on the organization's policies and procedures related to credentialing.
  • Developed and implemented a new system for tracking provider data which resulted in a 10% decrease in processing time for credentials verification.
  • Reviewed, updated, and created standard operating procedures (SOP) for the department; ensuring compliance with NCQA standards.

Credentialing Specialist II at Joint Commission on Accreditation of Healthcare Organizations (JCAHO), HISep 2021 - Mar 2022

  • Led the development and implementation of a new credentialing process that reduced processing time by 30%.
  • Trained and supervised 4 new staff members in credentialing procedures.
  • Reviewed and updated 50 provider files to ensure compliance with all regulatory requirements.
  • Conducted on-site visits for 10 providers to verify credentials and collect primary source documentation.
  • Participated in 5 site surveys conducted by governmental agencies or accrediting bodies.

Education


Associate of Arts in Business Administration at Hawaii Pacific UniversitySep 2017 - May 2021

I have learned how to manage my time, how to work in a team, and how to communicate with people.

Skills


  • Medical Terminology
  • CPT & ICD-10 Coding
  • Medicare Guidelines
  • Medicaid Guidelines
  • CAQH ProView Maintenance
  • NPI Number Assignment
  • ERAS Fellowship Documents