General Skill Credential Lookup

Credential Finder - Search

7 hours ago Credential Finder is just a demonstration of what you can do with transparent credential information. Take advantage of a complete suite of APIs and methods to build your own applications based on data in the Credential Registry. Use our trusted and relevant data to build your own custom solutions that help meet your specific needs.

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15 Essential Credentialing Specialist Skills For Your

12 hours ago

• 15 Essential Credentialing Specialist Skills For Your Resume And Career 15 Essential Credentialing Specialist Skills For Your Resume And Career1. Clinical StaffThe clinical staff consists of people who work under a healthcare professional like a physician. Their job is to assist in healthcare professional services but not to report them directly. The clinical staff has direct contact with patients for diagnosis, treatment, and further care.Here's how clinical staff is used on credentialing specialist resumes:Send communication via Outlook to notify clinical staff and appropriate departments with training approval and patient care responsibilities.Support all clinical staff with difficult or dissatisfied patients pertaining to pain management and narcotic prescriptions.Assured that referral guidelines provide appropriate clinical information and reimbursement paperwork for surgical scheduler.Credentialed and re-credentialed new and current clinical staff into different insurance panels.Coordinate with clinical staffing specialists to obtain required information from provider.2. ProceduresProcedures are the established ways to perform a certain task. It is like an action plan for a team to perform their duties. It's like a map that can save one from being confused or roaming about while attempting to achieve a goal. When an organization uses procedures, it promotes positive practices and sets a good precedentHere's how procedures is used on credentialing specialist resumes:Well-versed in primary source verification, communicating with insurance companies and maintaining policies and procedures according to The Joint Commission standards.Educated and supported company employees through training sessions of general knowledge of the credentialing processes and procedures resulting in increased productivity.Processed provider credentialing information which including verification of data in accordance with policies and procedures, to support credentialing processes.Developed policies and procedures for physician credentialing program to ensure that all medical staff have maintained necessary licensing credentials.Compiled comprehensive database of national hospitals and government agencies for department use and composed manual for credentialing procedures.3. Data EntryData entry means entering data into a company's system with the help of a keyboard. A person responsible for entering data may also be asked to verify the authenticity of the data being entered. A person doing data entry must pay great attention to tiny details.Here's how data entry is used on credentialing specialist resumes:Maintained credential database through ongoing data entry of practitioner updates with accuracy and in compliance of established integrity guidelines.Maintained accurate provider data in the provider database and other applications through accurate data entry and verification as necessary.Reviewed all provider applications and supporting documentation for completeness, and oversaw data entry through assigning to Credentialing Specialists.Performed audit reviews of completed credentialing files monthly to ensure quality, accuracy, timeliness and data entry accuracy.Coordinate and provide accurate data entry information regarding providers, on our billing office/ lab information systems.4. Customer ServiceCustomer service is the process of offering assistance to all the current and potential customers -- answering questions, fixing problems, and providing excellent service. The main goal of customer service is to build a strong relationship with the customers so that they keep coming back for more business.Here's how customer service is used on credentialing specialist resumes:Position also involved customer service, message distribution, and ancillary scheduling, preparation and referrals management.Provided exceptional customer services to internal and external customers by promoting open communication and exceeding their expectations.Manage customer service questions or other issues by answering questions concerning Radiologist licenses and registrations as needed.Manage customer service questions/issues by providing answers to questions concerning Radiologists' licenses and registrations as needed.Manage candidate's customer service needs, communicate effectively with recruiters about credentialing needs or updates.5. Health CareHealthcare means an organized service provided to people when they are diagnosed with a medical illness or suffer an injury. Basic health care would ensure to improve the health of the patient. Health care is provided by designated and certified specialists who can be doctors, registered nurses, therapists, etc. The healthcare of the people is the responsibility of the state as they set up hospitals and clinics for the public and arrange certified professionals in them for the health care of the people.Here's how health care is used on credentialing specialist resumes:Coordinated all aspects of the credentialing and primary source verification process for practitioners, health care providers and health delivery organizations.Coordinate and garner all materials and documentation for behavioral care professionals in becoming accredited members of health care insurance association.Processed credentialing and re-credentialing applications for health care providers by primary source and verification of all credentials.Maintain ongoing communication with health plan representatives, contracted providers and Family Health Care Clinic departments.Reviewed health care providers credentialing materials with special attention to timeliness and accuracy.6. Regulatory AgenciesA regulatory agency is a Public Benefit Corporation (PBC) that is responsible for supervising certain human activities and controlling them to some extent. They are set up in some areas such as hospitals, law firms, and governmental setup to regulate safety standards. They prevent undue and unjust abuse of power in these setups.Here's how regulatory agencies is used on credentialing specialist resumes:Provided timely reports to practitioners, departmental chairmen, and committees regarding focused reviews to ensure compliance with all regulatory agencies.Managed sensitive and confidential personal information for credentialing verification requirements with regulatory agencies, universities and hospitals.Maintain cooperative, effective relationships with physicians, insurance carrier, hospital and regulatory agencies.Partnered with outside regulatory agencies to collect relevant data and ensured accuracy of data.Trained and supervised credentialing staff to ensure compliance with the accrediting and regulatory agencies.7. Provider FilesPROVIDERfiles allow users to track all EAP referrals online using a secure and encrypted environment.Here's how provider files is used on credentialing specialist resumes:Protected and secured all provider files and private and confidential information in locked filing cabinets limiting access to authorized staff members.Maintained provider files and documentation of current professional licensees and certifications as well as planned participation through the health insurance carriers.Updated provider files through the credentialing and re-credentialing process as well as validated demographic information for reimbursement and directory database.Review and process incoming provider files, done internally or by Credentialing Verification Organization, including any delegated information.Maintained confidential records such as provider files, legal/clinical reviews and contracts and assisted with document preparation and correspondence.8. Primary Source VerificationPSV or Primary Source Verification is needed for confirming if an individual holds a valid certification, license, or registration to practice a particular profession as required by regulation or law. Methods for conducting PSV include direct correspondence, securing electronic verification, documented telephonic verification, or collecting reports from credentials verification organizations.Here's how primary source verification is used on credentialing specialist resumes:Performed primary source verification of physicians, allied health and other practitioners in accordance with departmental, accreditation and regulatory standards.Perform primary source verification for initial and re-credentialing of assigned providers utilizing NCQA Standards and other federal and state regulatory requirements.Provide technical and administrative support in all aspects of the credentialing and enrollment processes and completion of primary source verification.Perform primary source verification and data collection of all required documentation according to Joint Commission and NCQA standards.Communicated with physicians and their office staff, hospitals and other provider organizations to provide primary source verification.9. NcqaNCQA (National Committee for Quality Assurance) is an independent and non-profit corporation in the United States. It aims to improve healthcare quality by administering evidence-based programs, standards, measures, and accreditations. The National Committee for Quality Assurance works on a principle of analysing, measure, and improve. It seeks to develop consensus throughout the industry by working with employers, doctors, policymakers, and patients, along with health plans.Here's how ncqa is used on credentialing specialist resumes:Reinforced NCQA guidelines to assure efficient credentialing and move to delegated credentialing Designed and implement the credentialing software system-CACTUS.Conducted initial and annual credentialing and re-credentialing delegation oversight audits in compliance with NCQA and ICE requirements and guidelines.Supervised and delegate responsibilities to Managed Care Clerks to assure consistent application of NCQA Credentialing Policies and Procedures.Coordinate the credentialing and re-credentialing process for Specialty Hospital of Washington in accordance with NCQA guidelines.Verified authenticity of credentials on current physicians from delegated entities in accordance with NCQA guidelines.10. CaqhCAQH (Council for Affordable Quality Healthcare) is a network database that provides an online repository of data credentials for different insurance companies to have access to. The main purpose of CAQH is to acquire the credentials of healthcare professionals and provide these credentials to healthcare entities.Here's how caqh is used on credentialing specialist resumes:Enforced regulatory compliance and quality assurance by ensuring all provider information meets Massachusetts state guidelines when processing CAQH applications.Collect and process significant amounts of verification and accreditation information using Cactus and CAQH ProView.Maintained 75+ physician/practitioner files including OBHG provider database, individual CAQH profiles and physician rosters.Maintained all provider applications on CAQH while continuously evaluating applications for completeness.Complete primary verification of physician CAQH application for accreditation with proprietary network.11. Staff BylawsHere's how staff bylaws is used on credentialing specialist resumes:Process initial and re-enrollment applications for employed and contracted providers according to the Medical staff bylaws and credentialing policies.Ensured compliance with Medical Staff Bylaws and regulatory requirements flagging any issues identified during the credentialing process.Monitored proctoring of provisional staff members according to medical staff bylaws and department rules and regulations.Assisted in interpretation and enforcement of Medical Staff Bylaws and provided guidance when necessary.Coordinate temporary/emergency privileges per Medical Staff Bylaws.12. DEADrug enforcement agents are specialized law enforcement officers, deployed to fight crime, especially drug-related offenses like the purchase and sale of illegal drugs. DE agents are physically fit and trained with the proper understanding of the law, training, and education.Here's how dea is used on credentialing specialist resumes:Detailed spreadsheet information verifying hospital privileges, malpractice insurance, - DEA verification.Accessed various government websites for verification of DEA registration and board certifications.Verified whether DEA and OBNDD were both current, and if restrictions existed* Submitted complete applications to the Credentialing Committee for approvalAcquire and maintain provider's CDS, DEA, & NPI registration documents, verification, & related information as necessary.Verified and confirmed DEA, DPS Licenses as well as, but not limited to, Board Certifications for potential providers.13. Credential FilesHere's how credential files is used on credentialing specialist resumes:Processed initial application for all state and hospital licensing and credential process, administered all necessary paperwork, licenses and documentation.Provided administrative support to the Credential department, reviewed finished materials for completion, accuracy, and format, scheduled/coordinated events.Developed and implemented audit process to verify experience of approximately 4200 applicants per year seeking an ICF Individual Credential in Coaching.Review provider credential files against defined criteria to determine whether provider meets credentialing requirements for both initial and re-credentialing files.Provided effective communications with provider offices with a diversified population to promote relationships imperative to the credential process.14. CMSA Content Management System or CMS is computer software that works as a framework where content can be assembled and managed by using a database. CMS is an important asset in web development. This platform enables users to create, edit, collaborate on, publish and store digital content. It helps users to manage their content and modify it from a single system.Here's how cms is used on credentialing specialist resumes:Review application for completeness and accuracy of information using CMS approved procedures, guidelines and rules.Researched CMS guidelines as needed to complete application credentialing process and to respond appropriately to providers.Audited enrollment applications before submitted to CMS.Managed portfolio of managed care agreements; performed credentialing for CMS, SAM, and contracted health insurers/payers.Assured compliance with all standards and regulations including inspections by government agencies (JCAHO and CMS).15. Provider InformationHere's how provider information is used on credentialing specialist resumes:Researched and analyzed professional provider information, and institutional requests to assure its completeness for data maintenance necessary for claims processing.Maintain spreadsheets of all program and physician information including current status of provider information returned and appropriate applications submitted.Performed source verification on all incoming provider information Contributed to our Disclosure of Ownership TEAM and TN Medicaid projectVerify physician/provider information for managed care plans including communication with health plan representative and other staff as necessary.Coordinated, processed, and accurately input new provider information, adhering to formatting standards.What skills help Credentialing Specialists find jobs?Tell us what job you are looking for, we’ll show you what skills employers want. Get StartedThe eight most common skills based on Credentialing Specialist resumes in 2022., 10.7%, 10.6%, 6.0%, 5.8%, 5.5%, 4.3%, 4.2%, 52.9%
• 60,713 Credentialing Specialist Jobs 60,713 Credentialing Specialist JobsWhere do you want to work?0 selectionsFind JobsCredentialing Specialist Related SkillsCredentialing Specialist Related CareersCredentialing Specialist Related JobsWhat Similar Roles DoPrevious:OverviewNext: OverviewCredentialing Specialist SkillsUpdated August 18, 2021Email: [email protected] © 2022 Zippia, Inc.ZippiaCareers & JobsJob CategoriesBest Companies In

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