Usman Hussaini

I am a highly motivated Credentialing Specialist with a proven track record of identifying and capturing new business opportunities. Skilled in building and maintaining relationships with clients and partners to drive revenue growth. I am seeking a challenging role in a dynamic organization to leverage my skills and contribute to their success

Credentialing Specialist at Mind Vibe PC (2023-08 – Present)

A healthcare organization specializing in management services join the firm from Pakistan as work remotely.

• Monitoring the credential status of employees and ensuring timely recertification and renewal of credentials to maintain compliance with industry and regulatory standards.
• Maintaining and managing databases of employee or provider certifications, renewal dates, and credential files to ensure accuracy and accessibility.
• Managing the initial and ongoing credentialing applications, including those for medical staff privileges, insurance enrollments, and participation with third-party payers or health plans.
• Coordinating with healthcare providers, insurance carriers, regulatory bodies, and internal departments to verify credentials through primary source verification and resolve any issues related to credentialing.
• Supervising credentialing staff, managing team workflows, conducting audits, and ensuring adherence to organizational policies and regulatory requirements.
• Preparing reports on credentialing activities, approvals, denials, and compliance status for leadership and credentialing committees.
• Playing a role in performance management of credentialing staff and implementing best practices to improve the credentialing process.
• Managed and maintained accurate records of providers and facility documents, ensuring timely retrieval of missing documents.
• Proactively followed up with insurance payers on behalf of clients, initiating strong communication to expedite contracting agreements.
• Submitted online credentialing applications according to insurance guidelines and promptly provided required documentation.
• Completed application forms and additional applications necessary for insurance credentialing.
• Maintained comprehensive records of insurance data and documents received for credentialing of various facilities and providers.
• Handled routine email correspondence from insurance payers regarding credentialing applications, responding in accordance with requirements.
• Conducted regular follow-up on credentialing applications through phone calls and emails.
• Created and managed Credentialing follow-up sheets, including all relevant data received from different insurances.
• Provided all necessary additional information and documentation as requested by payers during the credentialing process.
• Prepared monthly credentialing summary status sheets for providers, offering a comprehensive overview of their application progress.
• Facilitated the retrieval of missing documents required for enrollment purposes.
• Submitted enrollment applications for EDI and EFT as per provided instructions, diligently following up until completion.
• Assigned tasks to subordinates, providing them clear instructions and guidance to enhance their performance and contribution to the department.
• Examined the tasks of subordinates and provided them valuable instructions as per necessary requirements.
• Resolved executive queries, compiled reports, and forwarded them to upper management and clients.
• Created NPPES, Pecos, I&A, CAQH and NPI registry profiles.
• Contract Negotiation.

Credentialing Manager at TBH Medical Billing Services (2020-03 – 2023-07)

A leading company providing Medical Billing services to medical and behavioral providers in deferent state of USA and also providing medial clinic healthcare services to their patients.

• I have successfully managed credentialing processes for over 120 providers during my serving period, ensuring 100% compliance with regulatory standards.

Credentialing Specialist at Medcare MSO Medical Billing (2018-10 – 2020-01)

A Medical Billing organization

• Gained in-depth knowledge of the credentialing and contracting processes for various laboratories and ancillary facilities across different U.S. states. During my time at this firm, I acquired extensive hands-on experience in lab credentialing and federal enrollment procedures, including the CLIA (Clinical Laboratory Improvement Amendments) application process.

B.COM – Punjab University (2010-08 – 2014-09)

MA – Punjab University (2017-05 – 2019-11)