SUMMARY
Hardworking and dedicated Certified Provider Credentialing Specialist (CPCS) with over nine (9) years experience. Proficient multi-tasker able to follow directions and maintain peak workflow. Excels at prioritizing to meet the demands of the company and its clients. Computer literate in Microsoft Office, Internet Explorer, Lotus Notes, as well as XP. Proficient in CACTUS software. Excels at oral and written communication skills. Punctual with excellent attendance. Flexible schedule as necessary. Steady work record and exemplary work ethic.
EXPERIENCE
July 2009 - present Credentialing Specialist UC Health - Alliance Partners-CVO
•Credential providers according standards of Alliance Partners, NCQA and Joint Commission
•Receive and process credentialing/privileging applications from providers and/or clients
•Verifying all information on application is complete and accurate
•Reviewing and verifying all credentials including license, schools and hospital programs, malpractice insurance, malpractice claims history, work history and employment background
•Enter all information into CACTUS database to preparing each file for committee peer review
Dec 2001 - March 2009 Credentialing Specialist Anthem Blue Cross Blue Shield
•Utilized CAQH database to gather provider background information and entered into CACTUS
•Reviewed background information for completeness and accuracy
•Verified information against reliable sources
oIncluding the National Practitioner Data Bank and American Board of Medical Specialties.
•Reviewing and verifying all credentials including license, schools and hospital programs, malpractice insurance, malpractice claims history, work history and employment background
•Schedule providers for committee peer review when all information is obtained
•Assisted in training and development of CACTUS, CAQH and Provider Tracking Database
Dec 2001 - Dec 2006 Credent...
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