Janean Petrie
***** **** ***** *******, ** ***** Mobile: 281-***-**** acg9oo@r.postjobfree.com
Objective
Obtain a position in a professional setting which will enable me to utilize and expand my knowledge
and skills while serving as an effective member of the team.
Experience
University of Texas Physicians (UTP) 2/2000 - Present
Manager of Delegated Credentialing & Provider Relations
• Direct all Credentialing, Provider Data and Delegated Credentialing functions while managing the daily
operations of the department including selection, training, and supervision of staff.
• Provide oversight and guidance to the Provider Data and Credentialing team to assure all timelines, accuracy of
data and work processes are met
• Assure all federal and state reporting requirements are met.
• Responsible for monitoring the verification process for the credentialing department.
• Completes physician and allied health professional verifications and ensures the
organization and staff are in accordance with standard credentialing procedures, health plan policies, NCQA, TDI
and CMS requirements
• Maintain current licensure (Including Medical License, DPS, DEA, Malpractice Certificates and Certifications)
• Coordinates and attends the Credentialing Committee Meetings
• Create and Maintain departmental policies and procedures
• Provide oversight of Delegated Groups, including Pre assessments and Annual Audits
• Manage and support data management processes to track and report credentialing and
• payer related data
• Generate monthly reports to contracted managed care companies, submitting new providers for loading purposes,
changes and terminations
• Develops relationships with payer contacts to facilitate information sharing and to resolve discrepancies in a timely
manner
• Partner with centralized departments to troubleshoot out of network payer issues and
• other payer related discrepancies as needed
• Educate physician and office personnel on managed care product lines
• Maintain Provider website, uploading of new providers, terminations and changes to
clinic locations
West Houston Medical Center 7/1998 – 2/2000
Credentialing Specialist
Primary source credentialing for initial and re-credentialed providers according to JCAHO
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standards
Responsible for maintaining current licensure on all providers
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Assist Director of Credentialing with special projects
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Woman’s Hospital of Texas 2/1997 – 7/1998
Credentialing Specialist (CVO)
Primary source credentialing for initial and re-credentialed providers JCAHO standards
•
Responsible for maintaining current licensure on all providers
•
1 Janean Petrie
Assisted with various department projects
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•
7/1996 – 2/1997
Fort Bend Medical Center
Physician Referral Representative
• Directed patients to Hospitals and Physician offices
• Managed patient appointments
• Met and exceeded department customer service goals
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Education & Training
Graduated 1987
Monte Vista Spring Valley, CA
• Leadership in Medical Administration
• Medicaid/Medicare Enrollment
• Medical Terminology
• MSL Quality Edge for Windows
• ECHO Health line Systems
References
Information is available upon request.
2 Janean Petrie