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Skills

  • Problem resolution
  • Project organization
  • Cross-functional team collaboration
  • Talent management
  • Recruitment
  • Training development
  • Customer service oriented
  • Risk management
  • Automated tracking systems for provider applications
  • HIPAA compliance

Work Experiences

  • Achieved a 79% reduction in credentialing delays.
  • Achieved recognition during the Innovation Award award event.
  • Achieved 48% accuracy in credentialing file audits.
  • Achieved compliance in 2021.
  • Collected and prepared detailed credentialing reports for monthly board reviews, leading to 18% faster approvals on submitted applicants.
  • Collaborated with procedure leadership.
  • Completed an overhaul of credentialing criteria for metric providers, leading to a 57% reduction in processing errors and delays.
  • Coordinated with 11 insurance payers to resolve billing and credentialing issues, significantly reducing claim denials.
  • Brainstormed and implemented continuous improvement initiatives, reducing overall credentialing process gaps and cutting approval times to 16 days.
  • Achieved results over 14 months.

Summaries

  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Consistently met or exceeded performance goals.
  • Achieved 29% efficiency gains.
  • Achieved 46% fewer delays.
  • Provider Credentialing Consultant with 2 years of successful project management and stakeholder engagement experience.
  • Achieved a 51% score.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Strong financial acumen with a track record of developing and sticking to budgets.
  • Within Miscellaneous, senior Provider Credentialing Consultant and outstanding performer in team leadership and client relations.
  • Addressed credentialing obstacles.

Accomplishments

  • Collaborated closely with payer networks to streamline provider insurance enrollments, increasing provider network participation rates by 44%.
  • Led cross-functional efforts to resolve credentialing bottlenecks, reducing provider onboarding time from 18 weeks to 11 days.
  • Spearheaded the transition to an electronic credentialing management system, resulting in 79% reduction in paper-based errors.
  • Collaborated with team of 15 in the development of framework.
  • Reduced issue resolution time for provider complaints by 28% by launching a customer-facing ticketing and tracking system.
  • Successfully negotiated contracts with new insurance carriers, expanding the provider network by 15%.
  • Increased the efficiency of the re-credentialing process, achieving 100% completion of tasks ahead of established deadlines for Six Sigma.
  • Developed and maintained a database of 17 providers ensuring accurate, up-to-date information for credentialing staff.
  • Ensured ongoing provider compliance with process, achieving a 11% success rate on third-party audits.
  • Led a credentialing team that consistently processed over 12 provider applications monthly, ensuring 100% compliance with payer requirements.

Affiliations

  • Freemason
  • Society of Human Resource Management
  • Society of Women Engineers
  • Volunteer for Healthcare Compliance and HIPAA Advocacy at system
  • Member, National Credentialing Forum Advisory Board
  • Co-Leader, Monthly Credentialing Reviews at procedure
  • Board Committee Member on Credentialing Policy at initiative
  • National Association of Social Workers
  • Credentialing Trainer for New Recruits at initiative
  • International Council of Nurses

Certifications

  • Certified Business Analysis Professional (CBAP)
  • Certified Outpatient Coder (COC)
  • Certified Revenue Cycle Specialist (CRCS)
  • Health Information Technology for Economic and Clinical Health (HITECH) Certification
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Google Certified Professional Cloud Architect
  • Lean Six Sigma Green Belt Certification
  • Credentialing and Enrollment Manager Certification (CEMC)
  • Master of Science in Healthcare Administration 2023
  • Certified Medical Office Manager (CMOM)

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