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Skills

  • Regulatory compliance
  • First Aid/CPR
  • Candidate Sourcing
  • Change Management
  • Customer service
  • Cost savings through process negotiation
  • Conflict resolution
  • Attention to detail
  • Adaptability
  • Talent management

Work Experiences

  • Upgraded a legacy HRIS system to new technology to minimize business impact.
  • Collaborated with IT to implement electronic credentialing software.
  • Collaborated with clinical operations.
  • Aligned credentialing procedures with organizational goals.
  • Created a continuous education program for credentialing specialists.
  • Collaborated with external auditors to present accurate provider information, successfully closing 13 complex audits with no identified anomalies.
  • Achieved 100% accreditation approval for 2015.
  • Created a provider credentialing dashboard.
  • Assisted senior management in making key decisions by developing and submitting performance and compensation reports with status updates and improvement recommendations.
  • Achieved compliance with process.

Summaries

  • Interim Credentialing Manager is a multi-talented Interim Credentialing Manager who is consistently rewarded for planning and operational improvements.
  • Analyzing company needs and developing long-term solutions to meet personnel objectives is second nature to me.
  • Proficiency in strategic planning and client relations.
  • Achieved a 61% reduction in credentialing errors.
  • Achieved 82% data accuracy improvement.
  • Boosted provider satisfaction.
  • Adept Interim Credentialing Manager.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Accomplished in facilitating audit preparation and management, reducing credentialing discrepancies by 82% and aligning departmental workflows with regulatory standards.
  • Aligned departmental workflows with regulatory standards.

Accomplishments

  • Coordinated credentialing processes across 8 clinic locations, ensuring compliance with both local and federal requirements.
  • Documented and resolved framework which led to method.
  • Monitored and evaluated credentialing KPIs, presenting findings to senior management that resulted in strategic adjustments improving compliance efforts.
  • Supported contract negotiations for 4 healthcare providers by ensuring credentialing compliance with state and federal regulations.
  • Collaborated with 8 insurance network representatives to ensure credentialing criteria were met, resulting in full network participation and contract renewals.
  • Implemented credentialing automation tools, reducing administrative workload by 70% and allowing for reallocation of resources.
  • Implemented a state-of-the-art tracking tool for licensure and certification expirations, reducing credentialing delays by 47%.
  • Increased accuracy of credentialing documentation by developing new quality control procedures, improving overall department accuracy by 22%.
  • Successfully led the department through 9 audits from framework, achieving zero deficiencies and maintaining full compliance.
  • Resolved product issue through consumer testing.

Affiliations

  • American Association for Physician Leadership (AAPL)
  • Accreditation Council for Continuing Medical Education (ACCME)
  • National Association of Managed Care Physicians (NAMCP)
  • American College of Healthcare Executives (ACHE)
  • International Council of Nurses
  • Society of Women Engineers
  • Credentialing and Privileging Task Force - procedure
  • Quality and Compliance Circle for Medical Providers (QCCP)
  • American Marketing Association
  • International Association of Administrative Professionals

Certifications

  • Certified Professional in Healthcare Quality (CPHQ) - National Association for Healthcare Quality (NAHQ)
  • Certified Medical Office Manager (CMOM) - Practice Management Institute (PMI)
  • Data Analytics and Reporting Certification - Microsoft Excel
  • Certified Business Analysis Professional (CBAP)
  • Health Informatics Certification - Ironclad Systems
  • Salesforce
  • Six Sigma Yellow Belt for Healthcare Professionals - method
  • Data-Driven Credentialing Systems Certification - Tableau Training
  • Certified Clinical Documentation Specialist (CCDS) – Association of Clinical Documentation Integrity Specialists (ACDIS)
  • SHRM Senior Certified Professional (SHRM-SCP)

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