Credentialing Specialist

Healthcare Provider Credentialing, Quality Assurance (QA), Provider Enrollment, Credentialing Audit. I was once and agent (Client Partner) before for US healthcare provider Credentialing Verification who used to call the Payer to verify the providers credentialing status. I also gather information on what are the requirements needed for the provider to enroll or to be credential with payer under their state. After 6 months of being an agent, I got promoted as a QA (Client Specialist). We audit the tasks made by the Client Partners. As a QA, I am responsible for making sure that credentialing work is accurate, compliant and met the Internal SOPs of the organization. We do file review and verification. Confirms licenses, DEA, Board Certs, NPI, Malpractice and CAQH data. We make sure that those are accurate, updated and properly verified. As a QA, we also responsible for error detection and correction. Flags discrepancies or missing items. Send files back to the credentialing team for correction. Tracks recurring errors to prevent future issues. We also do the audit preparations. We ensures that all files are audit-ready. Helps during internal and external audits and maintains documentation trails. Aside from tracking error rates, we also identify process gaps and recommend workflow improvements.