Energetic Credentialing Manager with 20 years experience in Healthplan, IPA, Medical Management , Medical Staff Credentialing. High-level executive support roles and leadership. Organize and professional with little supervision.
20 years plus experience with credentialing
Knowledge of hospital , IPA, Healthplan and Medical Management credentialing
Initial and Recredentialing of providers
Work closely with Medical Director and VP of Operations and Credentialing Committee Chairman
Healthplans audits score 100%
Monthly Credentialing Meetings
Maintain Credentialing Data base
Claims data entry on all providers
Exceptional data entry
Maintaining and updating Policy and Procedures according to ICE and NCQA
Excellent phone and email follow up skills
Responsible for Policy and Procedure implement
Track progress of out standing application Initial and Recredentialing
Teach staff on how credentialing impacts claims,contract and UM
Assist QI in quality of care issues
Train new staff
Bring healthplans audit score to passing
Clean up backlog of Provider
Primary Verification of ancillaries
Primary Verification initials appointments
Initial Appointments applications process
Supervisor of 3 office staff
Policy and Procedure Implement
Work closely with Director of QI , Medical Director and Um staff.
Facility audits on Medical Groups
Managed Care Chapter Certificate
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