Experience

Youme Healthcare
• United States
• Hospitals and Health Care
• 1 - 100 Employee
• Credentialing Manager

  • Aug 2022 - Present


Florida Autism Center - a division of BlueSprig

• Hospitals and Health Care
• 200 - 300 Employee

• Credentialing Specialist

  • Sep 2019 - Present

  Process initial applications and reappointments for hospitals and surgical centers as assigned byleadershipNegotiate and assist in contracting with payers.• Populate and prepare applications for providers.• Facilitate and Track onboarding paperwork and applications to and from providers.• Review provider applications for accuracy and completeness.• Perform primary source verifications to meet USAP required credentialing standards.• Maintain complete and accurate credentialing files of provider’s.• Monitor and notify providers of upcoming expirables, including expiring privileges, licensures, boardcertifications, MOC requirements and all other state and national required documents necessary forthe practitioner to legally and ethically perform under their scope of practice.• Maintain and update the credentialing database and medical staff services as provider informationand credentials change or renew.• Works closely with billing to resolve claim issues• Establish and maintain professional working relationships with providers and medical staff servicedepartments.• Demonstrate exemplary customer service to our providers and facilities.• Meet targeted credentialing deadlines and start dates. Proficient in CAQH, NPPES and PECOS• Performs other credentialing duties as requested.• Perform other duties as assigned. Show less

• Credentialing Specialist

  • Sep 2019 - Oct 2021



Med Advantage

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Account Lead/Credentialing Specialist

  • Aug 2015 - Sep 2019

  • Process initial applications and reappointments for hospitals and surgical centers as assigned by leadership Negotiate and assist in contracting with payers. • Populate and prepare applications for providers. • Facilitate and Track onboarding paperwork and applications to and from providers. • Review provider applications for accuracy and completeness. • Perform primary source verifications to meet USAP required credentialing standards. • Maintain complete and accurate credentialing files of provider’s. • Monitor and notify providers of upcoming expirables, including expiring privileges, licensures, board certifications, MOC requirements and all other state and national required documents necessary for the practitioner to legally and ethically perform under their scope of practice. • Maintain and update the credentialing database and medical staff services as provider information and credentials change or renew. • Maintain and update continuing medical education credits and other training requirements. • Establish and maintain professional working relationships with providers and medical staff service departments. • Demonstrate exemplary customer service to our providers and facilities. • Meet targeted credentialing deadlines and start dates. • Performs other credentialing duties as requested. Show less



CuraScript, Inc. An Express Scripts Co.

• Pharmaceutical Manufacturing
• 200 - 300 Employee

• patient client advocate

  • Dec 2010 - Jul 2015

  Handled inbound and outbound member, provider and physician calls . Answer questions related to insurance coverage for patients’ medications . Maintain accurate and complete documentation of all inquiries . Work with other operational departments to research and resolve mail order and claims issues . Work to research and resolve problems in a timely manner. . Resolved claim rejections for eligibility, coverage and other issues . Obtains and verifies insurance eligibility for services provided Show less



Delta Dental Ins.

• United States
• Insurance
• 700 & Above Employee

• Claims/ Credentialing Specialist

  • Aug 2005 - Oct 2010

  Research and responds to complex customer telephone, electronic, or written inquiries . Provided excellent service to customers with information regarding eligibility, benefits, and claims with emphasis on customer education, satisfaction and retention . Enrolled providers/dentists in the Delta dental network of dentist . Assisting in credentialing and updating providers accounts with NPIs, tax identification numbers, and address changes in the National Provider File. . Resolved claim rejections for eligibility, coverage and other issues Show less