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Credentialing coordinator

Frisco, TX
June 21, 2018

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Children’s Healthcare Feb 2018 – current

Credentialing Coordinator

•Process Credentialing applications for all Physicians, AHP, and Dentist ensuring accuracy of documents and data entry

•Performed primary source verification

•Increased productivity and improved efficiency by systemizing and creating a performance improvement plan for the re credentialing process

•Performed quarterly internal audits of licensure, DEA, ATLS PALS, BLS and ATLS to prevent expiring

•Analyze reports and maintain credentialing database

•Prepare credentialing files for audits

•Manage files in relation to the credentialing of new providers: application, contracts, current physician license, board certification and other pertinent forms

•Coordinate Fellowship application and interviewing process: maintain ACGME accreditation; provide ongoing support to fellows

•Conducts thorough background investigation on applicants file

•Utilizes the Cactus credentialing database optimizing efficiency, performing query’s, report and document generation, submits and retrieves National Practitioner Database reports in accordance with healthcare quality improvement act

•Accepts and promotes organizational goals and functions with minimal supervision

Texas Scottish Rite Hospital

Managed Care Credentialing Coordinator Oct 2016 – Feb 2018

•Credentials Physicians, AHP, and Dentist with Medicare, Medicaid and third party health plans

•Leads, coordinates and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicants eligibility.

•Quarterly internal audits of payor websites ensuring accuracy of provider information

•Maintained and updated all provider database

•Reviewed credentialing files and ran reports for potential red flags

•Knowledgeable in PECOS, MD Staff, One APP, App Central, Shift Admin, Sales Force, and Cactus

•Assisted in areas of budgeting, performance improvement, and compliance as needed

•Investigate and resolve payor issues

•Implemented audit systems to prevent expirables of state license, DEA certificates, BLS, ATLS, PALS

•Created and maintained great customer relations with health plans, personnel, and medical staff


Credentialing Coordinator

•Process, coordinates, monitors and maintains the credentialing and re- credentialing application process for all First Choice Emergency Room, University of Colorado Broomfield and Grandview, and First Texas Hospital physicians to ensure no lapse in privileges.

•Conduct thorough background investigations, research and primary source verification of all components of the application file to include: license, schooling, DEA, DPS, ACLS, PALS, ATLS, and board certifications.

•Identifies issues that require additional investigation and evaluation, and validates discrepancies and ensures appropriate follow up.

•Interface between providers and hospital staff to collect and maintain required information.

•Utilize One -App, Salesforce and Shift Admin database to track the workflow of the credentialing process from start to finish. This ensures ongoing compliance with accrediting and regulatory agencies (Joint Commission, NCQA, URAC, CMS, Federal and State) by tracking and updating expirables.

•Conduct internal file audits.

•Respond to inquiries from other healthcare organizations, interfaces with internal and external customers on day - to- day credentialing issues as they arise.

•Effective in leveraging and motivating resources of outside entities to meet credentialing objectives.

•Lead Physician Credentialing Committee meetings including completion of physician files, reports and meeting minutes.

DAVITA RX Aug 2013 - Jul 2015

Credentialing Coordinator / Financial Assistance Advocate

•Processed and completed all Medicare applications within the 30 day time frame.

•Implemented reasonable goals for the team, and held weekly meetings for management.

•Utilized time management, and saved the company on average of $10,000 per month in cutting cost of double shipping errors, assisted patients with research of grants and financial assistance programs for Chronic Kidney Disease, Crohn’s disease, HIV, Transplant Medications, etc.

•Assisted patients in choosing Medicare D plans that would decrease financial cost of medication needs.

•Implemented a uniform workflow, enhancing accuracy and quality of work for all teammates.

•Ensured follow up was completed on applications every 3 and 5 days.

•Implemented strategies to assist in budget goals

•Implemented policies on team building

•Passed audits with 95% internal and external

GOLDEN LIVING Jan 2011 - Feb 2012

Credentialing Coordinator

•Maintained credentialing files to ensure timely processing of license, DEA, DPS, ATLS, PALS, ACLS.

•Re - Credentialed physicians in a timely manner to ensure no lapse in privileges.

•Lead weekly credentialing meetings, Proficient in One App, Sales force, Shift Admin, operated on a 30, 60, 90 day notification system for expirables.

•Worked closely with physicians and management to ensure all physicians were adherent with necessary vaccines, and flu shots.

•Conducted thorough background checks on all Emergency Medicine, NP, CRNA, CAA, and all specialists for the company.

•Able to manage continuous NPDB checks on all physicians.

•Assisted in contract language and execution

PHARMACARE Apr 2006 - Sep 2009

Lead Pharmacy Technician

•Ensured accurate Insurance verification and billing.

•Proficient in third party billing, Medicare and Medicaid claims, Prior Authorizations and filing of Medicaid applications in a timely manner.

•Transplant specialist: ran daily reports on all immunosuppressant medications being filled.

•Researched State and Federal grants eligible to transplant patients.

•Assisted in reminder calls for appointments, scheduled transplant surgeries with the hospitals, assisted in fundraising to assist the patient with any financial needs prior to surgeries.

COSTCO WHOLESALE Sep 1998 - Sep 2009

Certified Pharmacy Technician

•Verified insurance claims, filled medication, auditing of medication.

•In charge of inventory, ordering from Bergan and Mckesson.

•Bubble packed medication, Medicare and Medicaid billing

•Coding of Diagnosis for medication

•Prior Authorizations

•ICD- 9 coding

•Provide great customer service

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