Results-oriented Credentialing Manager bringing exceptional strengths in [Provider Enrollment] and provider enrollment. Communication and leadership. Seeking leadership position in established company with potential for advancement.
Managed a team of 10 professionals 13 years of office experiences. Ensured that team members responsibilities were defined and understood. Identified and drove creative solutions for problems. Recruited, retained and developed staff. Tracked departmental output, implemented corrective actions. Communicated and advised hospital CEO or Designated contact person of the needed paperwork necessary to begin the application process for new physicians. Checked that all primary sources verification was completed.
Provider Enrollment Specialist, 10/2012
to 07/2015 Communcity Health System – Franklin,
TN Communicate & advised hospital CEO or designated contact person of the necessary paperwork to start the application process for new physicians. Obtain checklist items in a timely manner for each provider. Contacted top insurance plans to request provider enrollment application packages, and continue to follow-up with insurance plan by telephone and or email until enrollment process was completed. Completed required forms and application for changes or updates in billing systems including EFT and or notification of Athena. Performed re-credentialing for providers as needed. Completed applications for new acquisitions. Completed application for Medicare MAC changes and CMS.
Credentialing Senior Associate, 05/2007
to 06/2012 Cigna – Franklin,
TN Responsible for reviewing initial application in order to ensure completeness and accuracy , facilitation the collections and review of pertinent information and documentation. Verified education, licenses, work history information given. Other job related duties included, recruitment, returned mail, scheduling of services for credentialing purposes and potentially assisting with claims resolution.
High School Diploma: 1981 Maplewood Comprehensive High School - Nashville,
Coursework in Marketing, Business Management and Communications
Certificate: Business office Technologies,
1991 Davidson Technical College - Nashville,