** ********* ****** ********, ** *****

CELL PHONE 203-***-****

E-MAIL acunic@r.postjobfree.com

FRANCIS C. SHANAHAN

OBJECTIVE

Experienced, well-educated professional seeks opportunity to contribute positively to the management, training/mentoring, corporate policy development, and compliance aspects of a managed care or hospital credentialing program

SUMMARY OF QUALIFICATIONS

Strong experience with CVO and hospital provider credentialing & recruiting, physician & hospital relations, legal review, business reporting and analysis, state and federal regulatory agencies, corporate & state funded medical malpractice entities, technical writing & editing managed care policies and standard operating procedures, medical procedures and terminology, as well as staff development, training, and mentoring.

WORK EXPERIENCE

January 2016 – March 2016 Charter Oak Health Center

Hartford, CT

Compliance Analyst/Credentialing Specialist

Responsible for managing the credentialing and privileging of all licensed independent practitioners (LIP’s) other staff as identified by Federal Tort Claims Act (FTCA) regulations and guidelines. Responsible for implementing and monitoring enrollment with State Federal and commercial vendors, and communicating effectively and timely with internal and external entities.

June 2015 – October 2015 The Hardenbergh Group

New Haven, CT

Independent Contractor – Yale-New Haven Hospital

Managed the multi-specialty initial appointment and cyclical reappointment of all physicians and allied health practitioners duly privileged with the facility.

Jan 2015 – March 2015 Healogics, Inc.

Jacksonvllee, FL

Interim Credentialing Manager (Hospital/Provider Enrollment Services)

Oversaw the credentialing program for physician specialists employed by the organization’s wound care centers as well as establishing and maintaining relationships with healthcare facilities affiliated with contracted healthcare providers.

Oct 2014 – Nov 2014 Coastal Spine and Pain Centers

Jacksonvllee, FL

Interim Credentialing Director (Hospital/Provider Enrollment Services)

Oversaw the development of the enrollment and credentialing program for physician specialists employed by the organization as well as establishing and maintaining relationships with private and government payers and healthcare facilities affiliated with contracted providers.

June 2014 – Sept 2014 Doctors Plus, Inc.

Cooper City, FL

Credentialing SME Consultant (Provider Enrollment/Marketing of Credentialing Products & Services)

Marketing and provision of Credentialing, Compliance, and Provider Enrollment consulting services to organization’s national provider network

Jan 2014 – April 2014 UST Global

St. Augustine, FL

Healthcare Consultant – Credentialing Program RFP & Contract Procurement

Independent strategic consultant working with international IT & Business solutions corporation in coordination with national managed care organizations for the development of provider and facility Credentialing programs, policy and SOP improvements, and the training and mentoring of US and offshore program personnel

June 2012 – Sept 2013 American Association of Clinical

Endocrinologists

Jacksonville, FL

Socioeconomics Policy Project Coordinator (Physician Member Advocacy)

Coordination of activities in the department relating to healthcare financing and third party reimbursement, legislation, regulation (in consultation with the Department of Legislation and Government Affairs) and other factors which affect the practice of clinical endocrinology. Provides assistance to the Association membership on issues specific to endocrine coding and third party relations

May 2007 – June 2012 Medical Development International

Ponte Vedra, FL

Credentialing Manager (Hospital/Healthcare Facility Services)

Managed the initial appointment and cyclical reappointment of all licensed independent practitioners and allied health providers applying for initial credentialing and recredentialing for provision of healthcare services at Federal Bureau of Prison hospital facilities

Oversight of data integrity for information entered into provider information data management system as well as tracking primary source verification of medical credentials and completion of Federal Bureau of Prison background & security documents

Assist Health Services Reps, Clinical Medical Directors, and Contract Compliance Reps at client institutions with credentialing documentation maintenance for Joint Commission, ACA, and BOP program reviews and accreditation survey audits

Worked with Provider Network Development Managers and Regional Network Managers from designated regions to address issues regarding network status, application and compliance requirements, as well as documentation requests pertinent to the provider credentialing process.

Technical writing/editing for corporate/departmental policies and standard operating procedures to ensure compliance with state and federal accreditation and regulatory agencies.

Technical writing/editing contributions/assistance to the development of corporate RFP (Request for Proposal) documents

Researched and developed corporate credentialing and regulatory mandates for contract proposals under the direction of senior & executive management

Researched and developed corporate credentialing needs and compliance & accreditation mandates for technologies procurement under the direction of senior & executive management

Oversight of contracted outsourced credentialing for physician and allied health providers for Corrections Corporation of America facility employed practitioners

December 2006 – April 2007 Blue Cross/Blue Shield Florida

Incepture, Inc.

Jacksonville, FL

Contractor/Provider Data Services Integration – Ancillary Services

Oversight of contracting process for ancillary providers throughout state of Florida for Medicare Advantage PPO network project initiative.

Oversight of data integrity for information entered into provider database as well as tracking production results for contracting initiative.

Worked with Network Management representatives from designated markets to address issues regarding network status, fee and reimbursement schedules, as well as documentation requests pertinent to the contracting process.

Worked with Corporate Credentialing Unit to ensure timely processing of contract requests and credentialing process.

Worked with Network VP to facilitate contract approval and counter signature initiative.

Prepared Welcome Packets upon completion of contracting and credentialing processes.

Communicate with contracted providers to ensure seamless line of business contracting for Medicare Advantage PPO line of business.

Participate in Ancillary Services team meetings and development initiatives.

Participate in Medicare Advantage PPO update meetings to ensure compliance with project initiatives, processes, & goals.

August 2004 – May 2006 ValueOptions/TRICARE

Jacksonville, FL

Credentialing Manager (CVO Credentialing Services)

Managed the initial appointment and cyclical reappointment of all behavioral health providers applying for initial credentialing and recredentialing within the TRICARE South Region network.

Oversight of data integrity for information entered into provider database as well as tracking production results for Credentialing Specialist team.

Worked with Provider Relations representatives from designated markets to address issues regarding network status, fee and reimbursement schedules, as well as documentation requests pertinent to the provider credentialing process.

Managed production and quality reporting for the Credentialing Supervisor and Credentialing Specialists on a monthly, quarterly, and annual basis and conduct scheduled performance appraisals and coaching sessions, as necessary.

Ongoing review and maintenance of policies, SOP’s, and credentialing files in preparation for prime contractor URAC survey preparation audits

Technical writing/editing for corporate policies and standard operating procedures to ensure compliance with state and federal accreditation and regulatory agencies.

Prepared annual departmental budget forecast reporting

Designed and presented credentialing training curriculum for regularly scheduled new employee orientations as well as creating supplementary training guides for ongoing refresh training and mentoring.

December 2002 – August 2004 St. Vincent’s Medical Center

Jacksonville, FL

Credentials Specialist (Hospital/Healthcare Facility Services)

Managed the multi-specialty initial appointment and cyclical reappointment of all physicians and allied health practitioners duly privileged with the facility.

Oversaw the maintenance of the citywide physician and allied health practitioner roster for all healthcare providers privileged at facilities included within the citywide facility cooperative.

Worked with physician liaison with regards to initial appointment of contracted healthcare practitioners seeking privileges at the facility.

Coordinated and scheduled new physician orientations, monthly credentialing committee meetings, input credentialing related information into quality database, and perform post committee recording of meeting minutes and preparation of credentialing files for closure.

Ongoing review and maintenance of policies, SOP’s, and credentialing files in preparation for Joint Commission accreditation survey audits

February 2000 – February 2002 Aetna US Healthcare

Jacksonville, FL

Quality Consultant (CVO Credentialing Services)

Oversaw quality assurance of CVO processed initial and recredentialing applicants for presentation at market level Credentialing & Performance Committee.

Coordination and oversight of monthly credentialing committee meetings as well as completion of all designated post-committee reporting.

Review of CVO credentialing bulletins and communications against southeast regional quality management credentialing policies to maintain consistent regional compliance. Attended Southeast Regional Policies & Procedures Workgroup as representative of Credentialing Operations.

Oversight of HDO facility credentialing for north Florida market.

Oversight of delegated credentialing activities for all contracted facilities within the state of Florida including the sharing of performance data for PCP recredentialing applicants, performed annual audits to ensure compliance with NCQA and Aetna, Inc. policies and procedures, and actively pursued opportunities for expansion of delegated network.

Presented Florida delegation oversight audit results at monthly Quality Oversight Committee meetings.

Assisted state and regional Quality Management teams with credentialing policy, SOP, and file review & preparation during NCQA, AHCA, and HCFA accreditation processes at market and state levels.

Worked with Provider Relations & Network Management representatives to monitor recredentialing non-responder rates for the state of Florida. Worked with Quality Management counterparts as well as Network Medical Director to monitor and review all providers sanctioned by the Florida Agency for Healthcare Administration.

June 1998 – February 2000 Aetna US Healthcare

Middletown, CT

CVO Mentor & Trainer (CVO Credentialing Services)

Organized and prepared curriculum for training program.

Presented curriculum to trainees and demonstrated use of credentialing & verification technology.

Evaluated the performance of trainees and performed formal mentoring and follow-up support training for regionally assigned trainees.

Completed necessary mentor review and maintained regularly scheduled problem-solving sessions.

Attended regularly scheduled mentor related in-service classes to review educational techniques, procedures, and materials relevant to the credentialing process

May 1997 – February 2000 Aetna US Healthcare

Middletown, CT

Senior Quality Analyst (CVO Credentialing Services)

Verification of provider credentials utilizing a mainframe provider database and a "client-server" credentialing and verification system.

Ensured that verification activities were performed in compliance with the (11) NCQA credentialing standards that the CVO was accredited under.

Scope of responsibilities included providers within (3) classifications, (i.e. PCP's, Specialists, and Allied Health) for a specific geographical region.

Consistently exceeded the "bonusable" productivity standard of 160 applications per month within a turnaround time of 30 days at 98% accuracy to complete the verification process and prepare the provider file for market level peer review.

Acted as Dental Provider Coordinator for the Pittsburgh, PA market. Responsible for credentialing verification activities for Oral & Maxillofacial Surgeons while averaging approximately 60 applications per month at 98% accuracy

EDUCATION

September 1984 – May 1987 Southern Conn. State University

Bachelor of Arts – English New Haven, CT

GPA 2.9; Major GPA 3.2

July 2006 - Issued letter of eligibility from the Florida State Department of Education for temporary teaching certificate – in process of fulfilling requirements for permanent certification to teach English for secondary grades 6-12

TECHNICAL SKILLS

Snagit screen shot program (3+ years experience) – utilized in the creation and development of credentialing standard operating procedure user guide for Medical Development International Government Healthcare Services division

SharePoint Credentialing (5 + years experience) – utilized for document indexing, storage, and various credentialing reports, invoicing documentation, and inter-departmental communications

IntelliApp & IntelliCred (4+ years experience) - application management, provider enrollment, and credentialing software program

Cactus (5+ years experience) - application management and credentialing software program

Microsoft Excel (14+ years experience) – Medicare/Medicaid sanction reports for Aetna, Inc., St. Vincent’s Medical Center & ValueOptions,Inc.; Northeast Florida provider credentialing productivity reports for Aetna, Inc.; Regional provider network adequacy reports for ValueOptions, Inc.; Departmental financial forecast reports for ValueOptions, Inc.; Provider non-responder reports for Aetna, Inc.

Microsoft Word (14+ years experience) – Departmental Policy & Procedures creation/review for Aetna, Inc. & ValueOptions, Inc.; Provider & beneficiary correspondence for Aetna, Inc., St. Vincent’s Medical Center, & ValueOptions, Inc.; Mail merge document creation for network communications for Aetna, Inc., St. Vincent’s Medical Center, & ValueOptions, Inc.

Microsoft PowerPoint (14+ years experience) - Training & mentoring and new employee orientation curriculum and presentation materials for Aetna, Inc., ValueOptions, Inc., & St. Vincent’s Medical Center.

Microsoft Project (7+ years experience) – Initial & recredentialing annual forecast process reports, credentialing staff workflow & project assignment reports, and credentialing dept. managerial project reports for ValueOptions, Inc.

Microsoft Access (14+ years experience) – Demographic data entry & credentialing/quality management tracking reports for St. Vincent’s Medical Center, & ValueOptions, Inc.; Market-level credentialing & quality management forecast reports for Aetna, Inc.; Credentialing department productivity & quality audit reports for ValueOptions, Inc.

Enterprise Provider Credentialing System (5+ years experience) – Proprietary Windows-based credentialing program for processing of initial credentialing & cyclical re-credentialing of network providers as well as generating productivity & quality audit reports for Aetna, Inc.

Enterprise Mainframe Provider Database (5+ years experience) – Proprietary Rumba-based mainframe data system for collection and tracking of demographic, credentialing, & provider relations data for network health practitioners contracted with Aetna, Inc.

Additional Business Analyst Technical Skills - Analytical Skills, Data Rules, Documentation, Facilitation/Elicitation (Document Analysis, Focus Groups, Interviews, Brainstorming, Storyboarding, Requirements Workshops, Microsoft Suite, Project Life Cycle

Additional Business Analyst Artifacts Skills - Business Requirements Strategy, Business Requirements Document, Best Practices Meeting Agendas, Meeting Minutes, Peer Review Documents, Post Implementation Reviews, Quality Reviews, Risk Assessment, Work Breakdown Structure

Additional Business Analyst Soft Skills - Adaptability, Coaching & Developing, Collaboration, Communication, Conflict Resolution, Continuous Improvement, Critical Thinking, Decision Making, Effective Listener, Handles Complexities, Influencing, Leadership, Manages Detail, Customer Skills, Manages Conflict, Methodologies, Multi Tasker, Project Management, Problem Solving, Project Management, Strategic Thinker, Strong Client Relationships, Takes Initiative, Teamwork, Time Management, Writing Skills

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