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Skills

Continuous Improvement Initiatives
Customer service oriented
Problem resolution
Project management
File and records management
Relationship development
Time management
Resource planning
Change management for credentialing processes
Business operations

Work Experiences

Assessed compliance with state, federal, and process regulations, passing all audits with a 72% rating during 2015.
Collaborated with standard leadership to develop credentials that met Joint Commission standards, propelling the facility to pass inspection in 2020.
Brainstormed and implemented continuous improvement initiatives, reducing overall credentialing process gaps and cutting approval times to 16 days.
Assisted senior management in making key decisions by developing and submitting performance and compensation reports with status updates and improvement recommendations.
Conducted monthly board reviews.
Audited provider files for Portland, ensuring 46% accuracy for new applications submitted within 5 days.
Achieved 48% accuracy in credentialing file audits.
Achieved a 79% reduction in credentialing delays.
Cut administrative costs by $11 yearly.
Completed an overhaul of credentialing criteria for metric providers, leading to a 57% reduction in processing errors and delays.

Summaries

Achieved continuous audit success since 2019.
Provider Credentialing Consultant is a multi-talented Provider Credentialing Consultant who is consistently rewarded for planning and operational improvements.
Achieved 29% efficiency gains.
Applied regulations to ensure credentialing practices meet legal requirements.
Achieved success without citations.
Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the procedure business.
Collaborated with 6 insurance payers to resolve critical credentialing issues, contributing to a significant decrease in claim denials.
Provider Credentialing Consultant with 2 years of successful project management and stakeholder engagement experience.
Achieved a 51% improvement in processing times.
Analyzing company needs and developing long-term solutions to meet personnel objectives is second nature to me.

Accomplishments

Established key performance indicators (KPIs) to track the credentialing process improvements, resulting in 45% increase in on-time approvals.
Resolved escalated credentialing issues in partnership with HR, reducing provider onboarding time by 6 weeks.
Resolved credentialing-related billing disputes for 16 providers, reducing overall claim denial rates by 32% across Portland.
Collaborated with team of 15 in the development of framework.
Implemented an automated workflow system, reducing credentialing time for new providers by 63%.
Reduced issue resolution time for provider complaints by 28% by launching a customer-facing ticketing and tracking system.
Led cross-functional efforts to resolve credentialing bottlenecks, reducing provider onboarding time from 18 weeks to 11 days.
Collaborated closely with payer networks to streamline provider insurance enrollments, increasing provider network participation rates by 44%.
Identified process inefficiencies by utilizing data analytics, leading to a 45% reduction in credentialing turnaround time.
Provided leadership and set direction for a credentialing compliance department of 12, overseeing risk management initiatives.

Affiliations

American Marketing Association
Board Committee Member on Credentialing Policy at initiative
Credentialing and Privileging Task Force Member at program
Member of American Medical Group Association (AMGA)
American Health Information Management Association (AHIMA)
Certified Professional in Medical Services Management (CPMSM) through NAMSS
Association for Supply Chain Management (APICS)
Society of Women Engineers
Volunteer Credentialing Mentor for Emerging Professionals in Healthcare Denver
American Medical Informatics Association

Certifications

Certified Medical Manager (CMM)
Certified Healthcare Access Associate (CHAA)
Certified Healthcare Access Manager (CHAM)
Certified Professional Coder (CPC)
Apple Certified Associate (ACA)
First Aid/CPR Certified
Microsoft Certified Systems Engineer (MCSE)
Salesforce
Google Certified Professional Cloud Architect
Certified Managed Care Professional (CMCP)

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Provider Credentialing Consultant Resume Builder

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