11/2012-Present Credentialing Specialist Amerigroup
Compile and maintain current and accurate data for all providers. Complete provider credentialing and re-credentialing applications; monitor applications and follows-up as needed. Maintain copies of current state licenses, DEA certificates, malpractice coverage and all other required credentialing documents for all providers. Maintain knowledge of current health plan and agency requirements for credentialing providers. Maintain credentialing database.
8/2006-8/2012 Credentialing Coordinator New Mexico Cancer Center
Coordinate and administer the credentialing process for medical providers on behalf of a specified practice plan, or third party insurance payer organization, ensure that all credentialing and accreditation processes and procedures are completed in accordance to established regulatory and policy requirements.
8/2005-8/2006 Credentialing Manager Lovelace Sandia Health Systems
Provide planning, management, oversight and consultation for company credentialing activities. Prepare reports submitted internally and externally. Supervise staff and implements procedures and processes that ensure compliance with Policy and Procedures regarding Credentialing of Physicians, Nurse Practitioners, Clinical Nurse Specialists and Physician Assistants. Work with various departments, including the company Chief Medical Officer, to resolve complex credentialing and privileging issues.
3/2002-8/2005 Credentialing Specialist Lovelace Medical Center
Responsible for the completion of al...
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