Selundria Wilson
Lithia Springs,GA
Summary
Experienced Credentialing Specialist adept at conducting application reviews and primary source verifications. Excellent relationship-building, problem-solving and communication skills.
Overview
17
17
years of professional experience
Work History
Lead Credentialing Specialist
Medely, Inc
11.2021 - Current
- Monitoring Nursys Reports Quality Assurance(Audits for Recruitment Team as well as Merely
- Reviewing/Uploading Drug Tests
- Maintaining team email inboxes
- Monitoring, gathering and uploading expiring credentials for professionals on assignments
- Monitoring Competency review documents, assisting with compliance support questions in Slack
- Maintaining Travel Credentials
- Communication with Travel VMS Coordinators
- Communicating with professionals and travelers as needed
- Ensuring travel credentialing deadlines are met
- Maintenance of physician enrollment and CAQH profiles
- Prepared records for site visits and file audits
- Reviewing and processing provide applications with regulatory and client defined timelines while evaluating for accuracy and completeness
- Conduct primary source verifications such as a background checks and board certifications
- Complete re-credentialing applications
- Tracking and updating any potential discrepancies through all forms of communication
- Organize and participate in virtual client meetings for provider application status and/or any discrepancies that have been uncovered
- Audit and assign work
Operations Administrator
Allyon, Inc
10.2020 - 07.2021
- Recruit and identify candidates for open positions through various channels, including internal position responses, referrals, internet tools, direct recruiting , job fair etc
- Monitor and manage onboarding processes
- Keying new hire information into the payroll system
- Verify/Approve timecards for invoicing and timekeeping purposes
- Communicate with current employees for follow up regarding timecards, PTO/time-off requests
- Communicate with external employees regarding payroll documents or any other new hire requirements to complete personnel files prior to start dates
- Update new hire information by way of notes on candidate profiles in the ATS
- Initiate benefits enrollment
- Update benefits elections in benefits portal and payroll portal
- Assist employees with travel arrangements
- Communicate with vendors to extend reservations, place orders, update orders
- Process employee expenses for reimbursement
- Verify Credit Card Statements and reconcile accounts
- Assist with corporate culture activities as needed, such as event planning, life event celebrations, and employee satisfaction initiatives
Verification Specialist Team Lead
Advanced Infusion Solutions
03.2018 - 09.2020
- Assists with screening applicant/resumes, coordinating phone/in-person interviews
- Recognizes patients’ rights and responsibilities and supports them in performance of job duties: respects patient’s rights to privacy and confidentiality
- Verifies health insurance coverage and benefits for assigned payers etc., Humana Cigna, Blue Cross Blue
- Shield, commercial, worker’s compensation, and government/state insurance plans and determines patient’s responsibility
- Ensure claims are processed consistently
- Enters insurance information in CPR+ and notifies home office of any IV and high dollar drug and of coverage and benefits
- Review credentialing and re-credentialing files; obtain all primary source verifications and present completed compliant files to region for review
- Determines if pre-certification or prior authorization is required for insurance company
- Follows up on pending or expired authorizations
- Documents, in detail, phone calls, phone numbers, person spoken to and call details on a consistent basis
- Maintains a thorough understanding for NDC (Nations Drug Code) numbers, billing units, metric quantities etc
- Maintains a broad range of knowledge of insurance plans, medical terminology, billing procedures, government, and medical codes such as CPT and ICD-p coding
- Shares knowledge gained with other staff members and works as a team member interacts with others in a positive, respectful, considerate manner and performs other job related duties.
Provider Enrollment Credentialing Specialist Team Lead
Conduent
01.2016 - 02.2018
- Assists with screening applicant/resumes, coordinating phone/in-person interviews
- Assists senior recruiting staff with job fairs
- Prepare recruitment materials and post jobs to appropriate job boards/newspaper/colleges
- Credentialing specialists maintain regular cooperation and compliance with all regulatory, accrediting, and membership-based organizations
- Create and carry out various credentialing processes in relation to physicians, medical assistants, and various other healthcare professionals
- Ensures that all personnel and services adhere to facility and staff policies, department guidelines, regulations, and government laws
- Collect and process significant amounts of verification and accreditation information, and thus must constantly maintain and update accurate databases for both practitioners and facilities
- These databases include pertinent education, training, experience, and licensure content
- Prepares their own records for regular auditing, as well as maintain close communication with all appropriate practitioners to ensure that records are up-to-date and consistent
- Review credentialing and re-credentialing files; obtain all primary source verifications and present completed complaint files to region for review
- Generate weekly/monthly/quarterly/annual reports for regions
- Update all databases with deliverables for delegates
- Update and maintain all Credentialing department manuals
- Processes credentialing and re-credentialing applications of health care providers
- Contacts medical office staff, licensing agencies, and insurance carriers to complete credentialing and re-credentialing applications
Administrative Assistant IV
Division of Medicaid, Maternal, Child Health
08.2006 - 05.2015
- Assumed responsibility for a Medicaid eligibility determination caseload for a designated territory within a region
- Investigated and verified accuracy of information provided by recipients under the Medicaid programs to determine compliance with State and Federal laws, rules and regulations
- Determined an applicant’s eligibility for institutional care based on Stated and Federal guidelines and verifies the accuracy of information listed on the applicant’s applicants
- Maintained good public relations and customer service
- Collects eligibility data information
- Reviewed existing work procedures and revise as necessary
- Assigned, planned, reviewed, and coordinated the activates of staff over which supervision is exercised
- Answers correspondence concerning operation of the department
- Verified, records, and files claims, reports and other documents
- Exercised leadership qualities to perform all phases of programs within the bureau
- Performs a variety of administrative tasks dealing with fiscal management, strategic planning, legal compliances, and required reports related to the agency
- Performs general clerical functions in assistance to the administrative superior which requires operating general office equipment
- Organizes and schedules meetings
- Maintains calendar of events and personal agendas
- Maintains department/program files and records
Education
High School Diploma -
Callaway High School
Jackson, MSBachelor of Science -
Jackson State University
Jackson, MSSkills
- Data Acquisition
- Problem Resolution
- Provider Enrollment
- Credential Verification
Timeline
Lead Credentialing Specialist
Medely, Inc
11.2021 - Current
Operations Administrator
Allyon, Inc
10.2020 - 07.2021
Verification Specialist Team Lead
Advanced Infusion Solutions
03.2018 - 09.2020
Provider Enrollment Credentialing Specialist Team Lead
Conduent
01.2016 - 02.2018
Administrative Assistant IV
Division of Medicaid, Maternal, Child Health
08.2006 - 05.2015
High School Diploma -
Callaway High School
Bachelor of Science -
Jackson State University
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