Siddharth Nelson

Credentialing Responsibilities

• Managed end-to-end provider licensing & credentialing processes for RN, APRN, DEA, MD, DO, and PHSYN across multiple U.S. states, ensuring compliance with regulatory timelines and standards.
• Handled provider enrollment and payer enrollment with Medicare, Medicaid, and commercial payers (UHC, Aetna, BCBS, Cigna, Humana,), ensuring accurate submissions and timely approvals.
• Led credentialing and re-credentialing efforts with insurance payers, hospitals, and health systems, facilitating smooth provider onboarding and enrollment.
• Served as the primary liaison for clients, offering strategic guidance and resolving complex issues in licensing, credentialing, payer enrollments, and regulatory compliance.
• Oversaw and coordinated benefit eligibility and verification processes as part of the Revenue Cycle Management workflow.
• Drove efficiency and compliance by streamlining internal processes, reducing turnaround time for provider onboarding, credentialing, and payer enrollment.
• Delivered training, mentorship, and performance feedback to junior team members, promoting best practices in documentation, client communication, and regulatory compliance.
• Partnered with cross-functional teams to align RCM strategies with licensing, credentialing, and enrollment goals, contributing to improved cash flow and operational performance.
• Utilized tools such as CAQH, NPPES, PECOS, Availity, and payer portals to manage provider data, applications, and ensure timely updates and submissions.
• Maintained up-to-date knowledge of state and federal regulations impacting provider licensing, payer enrollment, credentialing, and revenue cycle workflows.
• Supported audits and internal quality assurance reviews, ensuring documentation accuracy, compliance, and audit readiness.
• Directed a team of credentialing specialists, overseeing work allocation, productivity monitoring, and quality control for provider licensing, credentialing, and payer enrollment activities.
• Established and monitored KPIs, SLAs, and performance dashboards for licensing, credentialing, and enrollment operations.
• Designed and implemented process improvement initiatives, automation strategies, and workflow optimization to reduce errors and accelerate turnaround time.
• Coordinated with compliance, legal, and finance teams to ensure provider files met HIPAA, NCQA, URAC, CMS, and payer-specific requirements.
• Led stakeholder communication and escalation management, addressing payer delays, provider documentation gaps, and regulatory challenges.
• Prepared and presented credentialing, licensing, and enrollment status reports and analytics to senior leadership, supporting business decisions and operational planning.
• Managed budgeting, resource planning, and vendor relationships related to credentialing software, background checks, and primary source verification services.
• Ensured successful audit readiness by maintaining comprehensive files, payer enrollment records, and compliance documentation.

(This company was my payroll I was working for Assured Health)

• Directed the full licensing lifecycle for MD, DO, RN, APRN, NP, PHSYN, and LCSW providers, ensuring compliance with state medical board requirements and regulatory timelines.
• Managed applications for Interstate Medical Licensure Compact (IMLC) and Nurse Licensure Compact (NLC) to streamline multi-state licensure and accelerate provider onboarding.
• Oversaw credentialing and re-credentialing with Medicare, Medicaid, and major commercial payers (UHC, Aetna, BCBS, Cigna, Humana), ensuring providers were panel-ready within payer timelines.
• Led provider and payer enrollment submissions through PECOS, CAQH, Availity, and payer portals, coordinating approvals for new providers, group enrollments, and facility affiliations.
• Coordinated Criminal Background Checks (CBC), fingerprinting, and sanction checks, tracking results as required by state and federal regulations.
• Ordered and validated provider transcripts through FCVS, Student Clearinghouse, and Parchment, ensuring compliance with credentialing and enrollment requirements.
• Monitored CME/CE requirements for providers to maintain active licensure and payer credentialing status.
• Conducted Primary Source Verification (PSV) of licenses, board certifications, work history, malpractice coverage, and NPDB screenings to meet NCQA/URAC standards.
• Supervised a credentialing and licensing team, streamlining workflows, reducing turnaround time for enrollments, and driving adherence to KPIs, SLAs, and audit readiness.
• Acted as the key liaison between providers, payers, hospitals, state boards, and internal RCM teams, ensuring seamless onboarding and operational efficiency.
• Provided end-to-end RCM project assistance, supporting benefit verification, eligibility checks, Billing system, EDI/ERA/EFT setups, and payer coordination to optimize reimbursement workflows.
• Maintained detailed records of provider licensing, credentialing status, expirations, and renewals; prepared compliance dashboards and reports for senior leadership.

(This company was my payroll I was working for Verisys Healthcare)

• Led the onboarding and transitioning of new RCM clients, ensuring smooth implementation from setup to go-live by conducting detailed needs assessments and system configuration analysis.
• Provided medical billing project assistance, including workflow setup, payer connectivity, eligibility/benefit verification, end to end RCM and EDI/ERA/EFT configurations to optimize revenue cycle performance.
• Configured and customized the RCM platform based on client-specific requirements; delivered workflow training and user support to providers and staff, ensuring effective platform utilization.
• Maintained strong client relationships by offering ongoing support, issue resolution, and process improvement guidance, resulting in high levels of client satisfaction.
• Documented client configurations, customizations, and onboarding processes; contributed to the development of best practices for client onboarding and billing workflows.
• Managed the credentialing department, supervising a team of specialists to ensure accurate and timely credentialing, payer enrollment, and compliance with regulatory timelines.
• Oversaw provider enrollment and re-credentialing with Medicare, Medicaid, and commercial payers, ensuring network participation and timely reimbursement.
• Developed, implemented, and maintained credentialing policies and procedures to meet regulatory and industry standards, including HIPAA, NCQA, and URAC.
• Collaborated with healthcare providers, payers, billing, coding, and compliance teams to resolve credentialing issues and ensure seamless end-to-end revenue cycle operations.
• Analyzed credentialing data and operational trends to identify areas for improvement, implementing corrective actions and presenting findings to leadership.
• Provided training, mentoring, and performance management to credentialing staff, driving efficiency, accountability, and professional growth.
• Coordinated onboarding and credentialing for new hires, ensuring timely completion of paperwork, background checks, training, and credentialing requirements.
• Built and maintained strong relationships with providers, payers, and stakeholders, ensuring clear communication and effective issue resolution.
• Ensured compliance with healthcare regulations (HIPAA, CMS, NCQA, URAC) and internal quality standards across medical billing and credentialing functions.

• Manage the end-to-end credentialing process, including verifying provider licenses, certifications, education, and work history & Guide healthcare providers through the onboarding process, ensuring they are enrolled with all necessary payers and insurance companies.
• Manage the end-to-end onboarding process for new healthcare providers, ensuring they are set up in the system correctly and efficiently.
• Ensure compliance with regulatory bodies (NCQA, URAC, CMS) and payer-specific guidelines & ensure timely submission and follow-up of enrollment applications.
• Conduct team meetings to discuss progress, address concerns, implement work improvements & Monitor team performance and productivity, offering guidance and feedback to maintain high-quality standards.
• Analyze and report onboarding metrics, identifying areas for improvement and implementing process changes as needed & develop and maintain onboarding checklists, workflows, and procedures to ensure consistency and efficiency.
• Lead and manage a team of onboarding and credentialing specialists, providing guidance, training, and coaching as needed & managing and resolving credentialing-related issues, ensuring high provider satisfaction ratings.
• Ensure all necessary provider documentation, such as licenses, certifications, and contracts, are collected, verified, and uploaded & oversee the integration of provider data into the RCM system, ensuring accurate setup of billing, insurance information, and payer details.
• Ensure that all provider onboarding activities are compliant with federal, state, and payer-specific regulations & maintain accurate records and documentation of all provider onboarding activities and processes.
• Track and report on onboarding metrics such as the number of providers onboarded, time to onboard, and system integration success rates & Implement process improvements to streamline onboarding, reduce delays, and improve provider experience.

• Set up Google Ad campaigns, including Search, Display, Shopping, and Video ads & set appropriate bid strategies (manual, automated, target CPA, ROAS) for maximizing performance.
• Develop and manage budgets for multiple campaigns, ensuring optimal spending and cost-efficiency & Allocate budget across different campaigns, channels (Search, Display, Shopping, Video), and bidding strategies to maximize ROI.
• Design comprehensive Google Ads strategies tailored to business objectives (lead generation, brand awareness, sales) & Define campaign goals, KPIs, target audience, and budget allocation.
• Utilize audience targeting options such as demographic targeting, interest-based, remarketing, and in-market audiences & implement advanced targeting strategies, including location, device, and language targeting.
• Implement and manage conversion tracking using Google Tag Manager, Google Analytics, and Google Ads conversion codes & set up goal tracking, phone call tracking, and other performance metrics to evaluate the success of campaigns.
• Identify areas for improvement and adjust bids, ad copy, keywords, and audience settings to optimize performance & test different ad formats and creative strategies (text ads vs. responsive ads) to maximize click-through and conversion rates.
• Regularly review keyword performance and adjust keyword lists by adding negative keywords, refining match types, and optimizing bids & Generate detailed reports on campaign performance, including impressions, clicks, conversions, and ROI.
• Regularly communicate with clients or internal teams to provide campaign updates, discuss progress, and address any concerns or adjustments & stay updated on the latest Google Ads trends, features, and best practices.
• Use automated bidding strategies, rules, and custom scripts to optimize and manage campaigns more efficiently.

• Coordinate and manage the overall onboarding process of a client, from initiation to go-live.
• Collect and analyze client data, including but not limited to billing information, payer contracts, and fee schedules.
• Verify that the setup of client billing information is correct in the RCM system & Configure billing rules, coding, and reimbursement logic.
• Perform the testing and validation of billing scenarios and workflows.
• Coordinate and manage the credentialing process for healthcare providers & Verify provider credentials, including licenses, certifications, and insurance participation.
• Obtain and maintain required documents, such as DEA certificates and malpractice insurance & manage the credentialing process with payers, including Medicare, Medicaid, and commercial insurance.
• Gather, verify, and maintain healthcare providers' credentials such as licenses, certifications, education, work history, and malpractice insurance & conduct primary source verification of provider qualifications, including education, licensure, training, and board certifications.
• Track and maintain provider credentials, ensuring that all required certifications, licenses, and insurance are up-to-date & resolve any issues or rejections that arise during the payer enrollment process.
• Stay up to date with compliance standards for credentialing, including those required by NCQA and URAC, & Submit applications for new providers to enroll with third-party payers and maintain payer contracts for the healthcare facility or practice.

• Process and reconcile account receivables and remittances.
• Receive Many EOB or ERA towards the payment of a claim & post these payments immediately into the respective patient accounts, against that particular claim to reconcile them.
• Conducted thorough insurance verification and benefit eligibility checks for government and commercial payers, ensuring accurate patient coverage before service delivery.
• Processed and tracked prior authorizations for high-cost procedures, medications, imaging, and surgeries, reducing claim denials and delays.
• Collaborated with providers and billing teams to clarify coverage limitations, co-pays, deductibles, and out-of-pocket costs for patients.
• Manage A / R accounts by ensuring accurate and timely follow-up and & Responsible for making calls to insurance companies to follow up for denial claims.
• Work with billing and coding teams to resolve denial-related issues, ensuring accurate and complete claims submissions.
• Identify and appeal denied claims, ensuring timely and accurate resolution.
• Follow up on outstanding claims, ensuring timely and accurate payment.
• Identify and resolve claims-related errors, ensuring accurate and complete claims submissions.