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credentialing Manager/Specialist/Coordinator

Location:
Cypress, TX, 77429
Posted:
January 06, 2015

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Resume:

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

standards

Responsible for maintaining current licensure on all providers

Assist Director of Credentialing with special projects

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

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

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



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