Senior Credentialing Specialist at Apollo Healthaxis (Nexify Health) (2025-08 – Present)
- Obtained and verified credentials for all licensed medical providers for initial credentialing.
- Collected or enrolled renewal of license such as medical license, DEA, Education, Work history, NPI, verified internships, residencies, Fellowships, Reviewed malpractice insurance.
- Verified and validated State Professional Licenses, DEA certificates, CDS credentials, board certifications, and educational backgrounds to confirm provider qualifications meet payer and industry standards.
- Managed end-to-end provider credentialing and re-credentialing processes for a US Health Insurance client, monitoring applications and conducting follow-ups with provider offices to ensure timely completion.
Senior Credentialing Specialist at SUTHERLAND HEALTHCARE SOLUTIONS (2019-12 – 2025-07)
- Perform primary source of verification of provider credentials including education, training, licensure, board certification and worm history.
- Track, monitor and process re-credentialing and expiring documents to maintain compliance.
- Work closely with internal teams to solve credentialing issues and escalations.
- Support audits by providing complete and timely documentation.
- Managed end-to-end provider credentialing and re-credentialing processes for a US Health Insurance client, monitoring applications and conducting follow-ups with provider offices to ensure timely completion.
- Verified and validated State professional licenses, DEA certificates, CDS credentials, board certifications, and educational backgrounds to confirm provider qualifications meet payer and industry standards.
- Administered provider Enrollment across multiple panels including Insurance Networks, Managed Care Organizations (MCOs), hospital affiliations, and specialty groups, ensuring compliance with regulatory standard and contractual agreements.
- Maintained and updated accurate provider profiles in CAQH, NPPES, OIG, SAM, Medicare Opt-Out, and CMS databases, ensuring data integrity across all platforms.
BUSSINESS ASSOCIATE at 24/7 KOHL'S PROCESS (2018-09 – 2019-01)
- Determined consumer needs to provide products and services appealing to larger market.
- Evaluated customer feedback and provided recommendation for improve.
