Customer Service Human Resource
Resume:
Sharlee LeBleu, CPCS
Professional February, *011 - Present
Experience Phoenix Children's Hospital
Phoenix, AZ
Manager, Provider Enrollment & Support Services
April, 2008 - February 2011
Phoenix Children's Hospital
Phoenix, AZ
Managed Care Services Coordinator
Coordinates all aspects of provider enrollment with contracted
managed care plans, including credentialing database maintenance,
document collection, application submission and CAQH data compliance
Responsible for provider enrollment policy evaluation, development
and maintenance and delegation planning activities
Proficient at identification and resolution of extraordinary
information, discrepancies and time gaps to minimize payor enrollment
timeframes
Provides support to Physician Revenue Cycle and Clinical Departments
to resolve provider enrollment and payment issues
Achieved full implementation of a paperless provider enrollment
process during 2009
Provides excellent customer service to inter-departmental associates
and provider enrollment representatives at the payor level
Proficiency and working knowledge of JCAHO, NCQA, URAC, Medicare,
Medicaid and standards, policies and guidelines for the
accreditation, certification or licensure of healthcare organizations
Supervision and management of two FTEs and serves on varied
workgroups and committees
Monitors payor compliance with contractual obligations and
performance guarantees
Facilitates delegation agreements and plan monitoring activities
August, 1989 - April, 2008
Medilert-IRIS
Phoenix, AZ
Director of Credentialing
Responsible for all daily management operations with direct
supervision of credentialing staff, client and practitioner services
unit, totaling 15 FTEs, including Human Resource functions
Accreditation compliance, policy development and maintenance, quality
improvement, contracting and marketing, which comprises annual policy
review, reporting to the Board of Directors and healthcare clientele
retention
Direct and manage all aspects of achieving and maintaining compliance
with healthcare clientele delegation by meeting or exceeding current
NCQA, JCAHO an AAAHC certification standards, including processing
practitioner applications and reviewing for healthcare clientele
provisions and criteria, primary source verification of contracted
credentialing elements and reporting
Participation in NCQA and CMS audits both internally and on a
contract basis with managed care plans
Training of direct reports, including professional coaching for
personal development and growth within the organization
Direct and manage all aspects of achieving and maintaining compliance
with healthcare clientele delegation by meeting or exceeding current
NCQA, JCAHO an AAAHC certification standards, including processing
practitioner applications and reviewing for healthcare clientele
provisions and criteria, primary source verification of contracted
credentialing elements and reporting
Education High School Graduate
1989
Monrovia, CA
Attended
1990
Pasadena City College
Pasadena, CA
Child Development & Psychology Studies
Attended
2005 - 2006
Rio Salado College
Tempe, AZ
General Studies
Credentialing Certified Provider Credentialing Specialist (CPCS), NAMSS - 1996 to
Certification Present
Competencies Proficient in numerous software products, including Word, Excel,
Visual FoxPro, QuickBooks and IntelliCred. Varied experience with
professional level accounting, budgeting and Human Resource functions
and contracting.
Professional Board Member, Secretary and Vice President, Healthcare Providers
Activities Credentials Verification Association - 2000 to 2005
Member, National Association of Medical Staff Services - 1995 to
Present
Member, Arizona Association of Medical Staff Services - 1995 to
Present
1256 East Grovers Avenue
Phoenix, AZ 85022
*********@*****.***
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