Available Upon Request Curriculum Vitae Medical Assistant / Credential

JERENICIA M. JOHNSON

**** **** *** ****** ******

COMPTON, CALIFORNIA 90221

Jerenicia@yahoo. com / ( 562) 712- 7106

OBJECTIVE:

To obtain a credentialing position that will enable me to use my strong

organizational skills while providing a mechanism to select and retain qualified

healthcare professionals.

EXPERIENCE:

8/ 2012 – 3/ 2013 Aerotek / AppleCare Medical Group, Credentialing

Specialist

• Responsible for processing all initial credentialing applications forPrimary Care

Providers, Specialist, Allied Health and Health Delivery Organizations according to

state and regulatory guidelines

• Manage, mail and track all re-credentialing applications according to company

policy

• Consolidate and process re-credentialing applications in a timely manner

• Run primary source verifications according to NCQA standards also verify

professional peer references

• Request facility site reviews for primary care providers and high volume specialist

• Maintain expirables i.e. Medical Licensure, DEA Certificates, Malpractice/Liability

Insurance, Board Certification, CLIA Lab Certificates, City Business Registration and

Tax Certificates

• Run monthly reports to conseve the integrity of the credentialing database

• Assist with audit preperation and committee meetings and all staff projects

• Ability to set priorities, manage time and work independently as well as part of a

team

• Excellent interpersonal and communication skills both oral and written

• Working knowledge of NCQA, DHS, CMS and HIPPAA guidelines

• Working knowledge of Microsoft Word, Microsoft Excel, and Microsoft Outlook

1/ 06 – 5/ 2011 HealthCare Partners Medical Group, Credentialing

Examiner II

• Accountable for the implementation and management of the initial and re-

credentialing process for contracted, staff model physicans and allied health

providers according to regulatory guidelines

• Analyzed all applications/information sent by physicians and providers and received

through federal and state queries and compared them to established criteria

• Ran extensive education and training verifications according to NCQA and DHS

guidelines including peer reference verifications

• Requested facility site reviews for primary care physicians and other high volume

specialists

• Credentialed and privileged contracted and employed providers for the Ambulatory

Surgical Center

• Ran monthly and quarterly monitoring reports to track sanctions and disciplinary

actions against all physicians and allied health providers

• Monitored health plan submission grids in regards to providers obtaining ID

numbers

• Assisted with committee meetings, minutes and health plan audit preparation

• Scheduled interim committee meetings for primary care physicians and high

priority providers

• Reviewed and consolidated files for accuracy and completeness

• Ensured all applications are credentialed and approved within the NCQA 180 day

timeframe with a personal goal of 2 weeks for PCP’S and 6 weeks for specialists

• Monitored and processed various group applications in regards to network

expansions to make sure providers are added to the group in a timely manner

• Reviewed and proofed all initial employed profiles for health plan submissions

• Maintained credentialing database

• Processed pcp/specialty change forms including researching discrepancies between

information provided by the physician and information received from internal

departments or federal and state queries

• Interfaced with all internal departments regarding physicians/providers who are in

the credentialing process and who are approved

• Resolved problems and questions regarding confidential issues discovered during

the initial/re-credentialing process

• Completed and submitted DHS MediCal and CMS Medicare enrollment applications

for staff model providers

• Also refined the Medicare and MediCal application process to achieve a faster

turn around time regarding enrollment

• Professionally handled highly sensitive and confidential information and

maintained an effective work flow system

• Ability to set priorities, manage time and work independently as well as part of a

team

• Excellent interpersonal and communication skills both oral and written

• Assisted in all staff projects

• Working knowledge of NCQA, DHS, CMS and HIPPAA guidelines

• Working knowledge of Microsoft Word, Microsoft Excel, and Microsoft Outlook

6/ 04 – 2/ 05 Helpmates Staffing Agency: Billing Clerk

• Responsible for maintaining billing module for shipping and receiving on several

accounts

• Processed orders

• Printed shipping labels for orders

• Printed Bills of Lading and Shipping Manifest

• Created Excel spreadsheets for inventory reports

• Worked with Exceed 3.6 and Manhattan Software

• Answered switchboard, filing, facsimile and photocopying

1/ 01 – 1/ 04 La Vida Medical Group & IPA – Credentialing Coordinator

• Maintained credentialing / re-credentialing files according to regulatory guidelines

• Ran accurate, complete and timely verifications of provider files

• Updated and maintained all Medical Licenses, DEA Certificates and Liability

Malpractice Insurances

• Ran extensive education and training verifications via internet and mail

• Reviewed and consolidated initial applications for accuracy and completeness

• Submitted approved provider profiles to appropriate contracted Health Plans

• Created Curriculum Vitae’s for several staff model (employed) providers

• Assisted in becoming fully delegated with 10 major Health Plans within 1 year of

employment

• Assisted with audit preparation and Committee Meetings

• Completed major network expansion projects for CEO of company

• Completed EZ-CAP systems conversion

• Worked closely with Provider Relations, Network Management, Quality Management

and Contracting departments regarding providers application status

• Requested site reviews primary care providers and high volume specialist

• Health Plan submission of providers

• Working knowledge of NCQA, DHS and HIPPAA guidelines

• Working knowledge of Microsoft Word, Microsoft Excel, Microsoft Outlook, Data

Entry, Filing, Typing and Facsimile

11/ 98 – 1/ 01 Pacific Health Corporations – Credentialing

Coordinator / Claims Assistant

• Obtained and updated all expired credentialing documents

• Consolidated and reviewed files for accuracy

• Submitted completed credentialing files to contracted Health Plans and CVO

• Scheduled Committee Meetings and completed approval verifications

• Data Entry and switchboard operations

• Assisted claims supervisor with providing a status on claims and check tracers

• Logged and distributed monthly capitation and claim payments

• Worked with Provider Relations on timely reporting and investigation of member

and provider grievances related to claims and capitation

EDUCATION:

1996 NEC Bryman College – Medical Assistant Certificate

1994 Centennial High School – Graduated with Diploma (3.0 GPA)

REFERENCES:

Available Upon Request

Contact this candidate