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Skills

  • Process equipment
  • Credentialing process management
  • File and records management
  • MS Office
  • Operational improvement
  • Conflict resolution
  • Talent management
  • Cost savings through process negotiation
  • Employee relations
  • Recruitment

Work Experiences

  • Achieved Employee of the Year in compliance readiness.
  • Upgraded a legacy HRIS system to new technology to minimize business impact.
  • Was in charge of administering benefit programs, analyzing compensation and other competitive data, and creating budgets.
  • Achieved 100% accreditation approval for 2015.
  • Cut average spend on credentialing errors by $17.
  • Created and implemented a continuous education program for credentialing specialists, improving departmental efficiency and increasing employee retention by 21% over three years.
  • Cut verification delays from 7 days to 14 days.
  • Achieved President's Club recognition by senior management.
  • Communicated directly with providers.
  • Collaborated with external auditors to present accurate provider information, successfully closing 13 complex audits with no identified anomalies.

Summaries

  • Conducted proactive auditing.
  • Adept Interim Credentialing Manager.
  • Clear understanding of workflow optimization and process improvement as well as workflow optimization training.
  • Costs were consistently reduced while profits were increased.
  • Achieved zero deficiencies consistently.
  • Boosted provider satisfaction.
  • Aligned credentialing protocols with regulatory best practices.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Achieved a 61% reduction in credentialing errors.
  • Accomplished Interim Credentialing Manager.

Accomplishments

  • Proactively managed credentialing compliance concerns for 14 providers following updates in state-level healthcare requirements.
  • Developed and standardized a comprehensive credentialing process across 15 departments, reducing processing errors by 39%.
  • Increased accuracy of credentialing documentation by developing new quality control procedures, improving overall department accuracy by 22%.
  • Collaborated with 8 insurance network representatives to ensure credentialing criteria were met, resulting in full network participation and contract renewals.
  • Partnered with HR to streamline the onboarding process, integrating credentialing tracking into HR software which improved transparency and speed by 46%.
  • Centralized performance metrics reporting which led to data-driven changes that improved credentialing process efficiency by 43%.
  • Monitored and evaluated credentialing KPIs, presenting findings to senior management that resulted in strategic adjustments improving compliance efforts.
  • Analyzed and reported key credentialing performance statistics, enabling leadership to make informed decisions that improved framework.
  • Resolved product issue through consumer testing.
  • Created a comprehensive credentialing training program for new hires, which reduced onboarding time by 18 weeks.

Affiliations

  • Rotary International
  • Healthcare Financial Management Association (HFMA)
  • American Marketing Association
  • Jaycees
  • Quality and Compliance Circle for Medical Providers (QCCP)
  • Federation of State Medical Boards (FSMB)
  • National Committee for Quality Assurance (NCQA)
  • Professional Association of Healthcare Office Management (PAHCOM)
  • Association for Supply Chain Management (APICS)
  • Freemason

Certifications

  • HIPAA Compliance Officer Certification - metric
  • Certified in Healthcare Privacy Compliance (CHPC) - Health Care Compliance Association (HCCA)
  • Project Management Professional (PMP) – Project Management Institute (PMI)
  • Systems and Processes Certification for Credentialing Software - process
  • Six Sigma Yellow Belt for Healthcare Professionals - method
  • Health Services Management Certification - National Association of Healthcare Professionals
  • CompTIA A+ Technician
  • Compliance and Regulatory Affairs in Healthcare Certification - Beacon Labs
  • Certified Provider Credentialing Specialist (CPCS) - procedure
  • Cisco Certified Internetwork Expert (CCIE)

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