Nolan Smith
Concord
Summary
Detail-oriented Credentialing Specialist II skilled in managing provider credentialing and re-credentialing processes. Proven ability to ensure compliance with NCQA and DHCS regulations while maintaining accurate provider data and supporting audit readiness. Played a key role in supporting the department during a significant 10-county network expansion, contributing to seamless provider onboarding and operational efficiency. Strong communicator adept at collaborating cross-functionally to improve credentialing workflows and maintain quality standards.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Credentialing Specialist II
Partnership HealthPlan of California
03.2023 - Current
- Collaborated with healthcare providers to gather necessary information for accurate credentialing decisions.
- Provided exceptional customer service to both internal and external stakeholders, addressing inquiries promptly and professionally.
- Managed re-credentialing cycles in compliance with NCQA, CMS, DHCS, and other standards.
- Facilitated communication between departments, resulting in improved collaboration during the credentialing process.
- Received and evaluated applications to look for missing and inaccurate information.
- Conduct primary source verifications (licenses, board certifications, education, work history, etc.).
- Maintained 98% file accuracy during audits.
- Prepared records for site visits and file audits.
- Authored comprehensive desk-level procedures to streamline the credentialing process and support the onboarding of new specialists.
- Partnered with multiple departments to develop and launch a streamlined process for integrating new groups into the network.
- Generated and distributed approval letters to providers as part of the credentialing and re-credentialing process, in accordance with organizational policies and timelines.
- Ensured compliance with all DHCS and NCQA regulatory requirements to support audit readiness, and maintain accreditation standards.
- Collaborated with team members to prepare accurate and compliant rosters for NCQA accreditation submissions.
- Track and report metrics related to credentialing timeliness and file completeness.
- Schedule credentialing committee meetings, and prepare related documentation.
- Provide guidance to Credentialing Specialist I team members, and assist in training as needed.
Order Management Specialist
Bioventus
08.2021 - 02.2023
- Researched and addressed customer inquiries, questions and issues to promote optimal customer service.
- Contacted customers to verify or add to existing information, consistently providing timely, accurate and customer-oriented service.
- Worked closely with territory reps to get the orders completed in a timely matter
- Fielded incoming calls daily and addressed order questions and concerns to serve customer needs.
- Monitored and tracked customer orders.
- Informed customers of shipping dates, tracking and order information.
- Learned company products and services and communicated effectively to patients regarding product.
- Entered in orders proficiently and accurately in a timely manner.
Medical Records Lead
Muir Orthopaedic Specialists
06.2016 - 07.2021
- Sorted materials and filed according to guidelines.
- Reviewed charts and flagged incomplete or inaccurate information.
- Prepared mailings of information and documentation.
- Evaluated department procedures and recommended improvements to maximize efficiency.
- Trained 9 direct reports on department procedures and policies to maximize department effectiveness.
- Received and routed medical records.
- Received and processed medical records requests.
- Adhered to all facility, company and legal guidelines.
- Interacted and communicated easily with department personnel and public.
- Processed medical records requests from outside providers according to facility, state and federal law.
- Input data into computer programs and filing systems.
- Created new physical and computer-based files.
- Audited records for accuracy.
- Responded to materials requests and retrieved necessary information.
- HIPPA compliant
- Efficient in ICD-10 codes and insurance verification
Education
No Degree -
Diablo Valley College
Pleasant Hill, CAHigh School Diploma - undefined
Brionees
Martinez, CA05.2014
Skills
- Provider credentialing
- Document review
- Employee onboarding
- Data management
- Workflow & Process Improvement
- Reporting & Roster Preparation
- Policy & Procedure Development
- NCQA and DHCS Compliance & Standards
- Provider Credentialing & Re-credentialing
- Primary Source Verification
- Attention to Detail
Certification
AACP - Online Certification: Medical Coding 11/2020
Timeline
Credentialing Specialist II
Partnership HealthPlan of California
03.2023 - Current
Order Management Specialist
Bioventus
08.2021 - 02.2023
Medical Records Lead
Muir Orthopaedic Specialists
06.2016 - 07.2021
High School Diploma - undefined
Brionees
No Degree -
Diablo Valley College
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