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Yyyyyy x. yyyyyy

P.O. Box 0000 xxxxxx xxxx , xxxx , xxxxx 00000


Summary of Qualifications

  Credentialing Coordinator with more than seven years of valuable, hands-on healthcare experience.

  Strong knowledge of managed care operations, including working with dentists and office managers.

  Collaborated with other departments to determine IPA provider specialty needs.

  Stellar knowledge of credentialing standards and requirements for the National Committee for Quality Assurance (NCQA); National Practitioner Data Bank (NPDB); NPI (National Provider Identification); OIG (Office of Inspector General); U.S. Drug Enforcement Agency (DEA); Cardiopulmonary Resuscitation (CPR); and DBOC (Dental Board of California), among others.

  Familiar with re-hire eligibility, recruiting verification, attestation statements and malpractice coverage and professional liability.

  Proficient with Microsoft Office Suite and Access; Cactus; FlexCare Credit; Raintree; QuickBooks; Peachtree; Lotus Notes; AS/400; ADP Virtual Edge; and Automated Tracking Systems (ATS).

  Fluent in English and Tagalog.

Professional Experience


  Developed and maintained standard processes for credentialing data, ensuring database integrity and compliance with legislative, regulatory and accrediting body requirements.

  Received and processed necessary forms and reports related to credentialing.

  Verified licenses according to WDS rules and regulations pertaining to the credentialing process.

  Performed Primary Source Verification for credentialing and confirmed facility accreditation and licenses.

  Communicated effectively with other departments regarding the credentialing process, including billing, quality management, human resources, professional staff and dentists.

  Telephoned providers to proactively communicate critical expiration dates and monitor status.

  Followed up with personnel in the network contracting and provider relations departments when provider applications were incomplete.

  Participated on the Credentialing Committee, including coordinating record minutes and preparing files, and also served on a Peer Review Committee.

Work History


Office Assistant, Name of Social Services Agency Santa Ana, CA Mar. 2015-Present

Credentialing Data Specialist, Beacon Health Strategies Cypress, CA Apr. 2014-Dec. 2014

Self-Employed Anaheim, CA Apr. 2012-Mar. 2014

Credentialing Coordinator (promoted in Jan. 2006), Western Dental Orange, CA Sept. 2005-Apr. 2011

Accounting Clerk, Advanced Tax and Financial Advisors, Inc. Fountain Valley, CA Apr. 2004-July 2005

Education and Training


Bachelor of Science (BS), Business Accounting and Business Management (double major); earned 2007

Southern California Institute of Technology

Associate of Arts (AA), Accounting; earned 2003

Coastline Community College


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