Patricia Cardinal

713-***-****

***** ****** * ******* ** #2102

acfg9s@r.postjobfree.com

Objective I am a goal oriented front line manager with 6+

years of proven success in

healthcare credentialing, quality assurance

operations, and managing staff, seeking to secure a

position utilizing my extensive knowledge of the

healthcare field to become part of a team in a

fast-paced managed care organization.

Professional Accomplishments

Provider Relations/Credentialing/Contracting

. Over 6 years of experience in healthcare

credentialing

. Management experience

. Complex problem resolution; both members and

providers

. Involved in updates to Provider Relations and

Billing Policy and Procedures

. Able to flow between Member/Provider and

Contracting/Billing/Credentialing dynamics for

optimal results

. Enhanced and expanded Network Development

processes; Physician Recruitment

. Coached, Trained and Oversight of 6+ staff

members in both Provider Relations and Billing,

. Superior oral and written communication abilities

Work with minimal supervision

Developed and implemented provider and facility

site visit procedures

Professional Skills

. Computer literate (MS Word, Excel, PowerPoint,

Access)

. Master Negotiator

. Project driven, Quality Assurance

. Managed Care

. Billing/Claims resolution

. Customer Service Professional

Work experience 08/2013 - present Diabetes America

Houston TX

Credentialing Supervisor/Contract Specialist

Supervise Credentialing Staff

Managed Care Contract Management; tracking of fee

schedules, Maintained database of PPO, POS, HMO,

FFS, Contracts

Processed credentialing/re-credentialing files

according to all accrediting and regulatory

agencies.

Initial and subsequent credentialing to health plan

carriers

Initial and subsequent training of staff

Medicare PECOS Enrollment, CAQH

Resolved credentialing and contracting issues

Chaired department/interdepartmental meetings

Generated weekly reports to track initial

credentialing due dates.

Other credentialing related duties as assigned by

the management team

Local and regional travel

06/ 2007-08/2013 Interface EAP

Houston TX

Provider Relations Senior Associate - Team Leader

Supervised staff in Provider Relations and Billing

Departments

Process and troubleshoot EAP bills and managed care

claims

Maintain provider and facility databases; provider

and facility negotiations and contracting

Recruited and negotiated facility contracts

Provider and facility initial credentialing and

re-credentialing processes

Quality assurance activities utilizing the PDCA

cycle, developed a Quality Assurance program

(Performance Improvement Initiative) for the

Operations Department

Regional and local travel for Network Development

Recruited providers for Network Expansion

Project driven- determining areas of improvement

and oversee project development

Worked with management approval to update

departmental Policy and Procedures

03/ 2006-06/ 2007 United Recovery Systems Houston

TX

Professional Debt Collector

Negotiated settlements for charged off and

pre-charged off debt

Educated consumers on credit issues and trained new

debt collectors

11/2000-10/2005 MD Anderson Cancer Center Houston

TX

Patient Services Coordinator

Interpreted and coordinated physicians' orders to

schedule diagnostic tests.

Trained new Patient Services Coordinators

Worked with other departments to coordinate patient

schedules/resolved difficult scheduling issues

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