Credentialing Coordinator Resume
LOG IN OR REGISTER TO CONTACT ME
This button will open the login/register page in a new tab. After logging in, come back to this page and refresh your browser.
Resume:
Professional Experience
The Round Top Collection – Sr. Account Manager November
- Responsible for scheduling customers in Houston & the surrounding areas for pick-up on their orders
- Customer Service calls regarding damages, issuing credits and replacing damaged product
- Back-up Receptionist responsible for phones, faxes and copies
- Attend Home & Garden Market shows and sell product for The Round Top Collection, twice a year, January/July in permanent showroom in Dallas
- Work The Nutcracker Market, a Charity Event, one time a year in Houston
Houston Eye Associates July -November
Credentialing Coordinator
- Responsible for Credentialing & Recredentialing thirty eight physician office, both the main clinic and satellite offices
- Responsible for keeping Medicare/Medicaid License updated and current
- Responsible also for credentialing for the Houston Hearing Center
Health First TPA, Houston, TX -
Pharmacy Benefit Administrator, July
- Acted as the liaison between the Member and the PBM (Pharmacy Benefit Administrator). With my access to the PBM’s eligibility, I performed updates to eligibility or added prior authorizations, in the event a member encountered an issue, whereby their prescription was rejected at the pharmacy
- Responsible for implementing the ID card process. The ID card process was mocking up each ID card, both medical & dental for each Member. This process included setting up a draft of data information to be used on the ID card
- Responsible for mock up, sending ID card to vendor for approval. Vendor would mock up the ID card and send it back for approval. Once approved the ID cards would be printed and mailed out to the Members/Clients
- Attended pharmacy conferences and worked closely with several PBM’s. Stayed up-to-date on new drug availability by attending several out of state pharmacy conferences and working closely with the PBM’s.
- Worked closely with Account Managers to keep them abreast of cost saving measures for clients, i.e., considering generics first, implementing specialty pharmacy for bio drugs and pill splitting.
Health Administration Services, Inc.
Credentialing Coordinator
- Credentialing of approximately , physicians for our in house PPO network, Premier.
- Evaluate provider needs in a specific geographic location or area of specialty and solicited providers as needed
- Responsible for maintaining and updating information on these physicians
- Scheduled and prepared a credentialing meeting for new physicians twice annually
- Accessing the National Practioners Databank; checking litigation on the physicians before presenting to the PPO Board of Directors
- Develop, distribute and maintain PPO directories
- Responsible for formatting, proofing and setting up the directory for print
- Process letters to providers who are referring out-of-network or are not in compliance with claims guidelines
- Assist in the maintenance of provider contract files
Health Administration Services, Inc.
Eligibility
- Updated eligibility for members
- Updated student status on dependents
- Communicated any changes daily with the clients
Health Administration Services, Inc.
Client Services/Mailroom
- Opening and day stamping each piece of mail
- Refiling claims
- Copying files for Stop Loss claims
- Back-up for all outgoing mail and checks
- Delivering mail throughout the company
- Relieving the Receptionist for breaks and lunch
Accomplishments
- Medical Terminology
- Word
- Access
- Excel
- Quickbooks
- Net Suite
- Exceptional Assistant Seminar
Education
- John H.Reagan High School, Houston,TX. Obtained High School Diploma
Earlier Career Summary
- Receptionist, X-ray Department Park Plaza Hospital
- Houston Police Dispatcher
