Data Entry Medical
Resume:
Jean Piolet
Corinth, TX *****
Email address: **********@*****.***
Ph. 469-***-****
OBJECTIVE
To effectively utilize my skills and ability as a Credentialing Specialist to enhance, meet challenges, deliver results, and be a contributor to the overall success of an organization.
SUMMARY OF QUALIFICATIONS
Effective interaction with customers and all levels of management
Computer literate; working knowledge of MS Word, Excel, Outlook and Lotus Notes. Credentialing software: Cactus, Symed/One App Pro, Echo, Med Advantage, Symplr/Medkenetics, Salesforce and various other in-house credentialing software
Ability to prioritize workload in fast-paced and stressful environments; functions well independently or as a team member
Proven ability to multi-task and prioritize workload, meet targeted deadlines; team player, customer focused
Skilled physician and mid-level provider credentialing
Effective time management skills; positive work ethnics, strong organizational skills, detail oriented
WORK HISTORY
HSHS St. Elizabeth’s Hospital (CVO) Belleville, IL
Credentialing Specialist 9 2017 to 12 /2018
Worked as a credentialing specialist for a not-for-profit system of hospitals in the southern and central Illinois regions
Performed primary source verifications for initial and reappointments of medical staff and mid-level providers using various online resources
Created and maintained electronic files as needed for all new and existing providers
Ensure files were completed within the specified time frame according to NCQA and credentialing policy and procedure
Generate letters and reports from credentialing database
Follow up with the practice managers on requested documents/information needed to complete the file
Coordinated with the practice and MSOs to ensure targeted dates were met and informed them of any potential delays that would affect a provider’s scheduled start date
Notified the MSO of files as they were completed and being released back to the facility for review prior to credentials committee, including a summary of concerns report of any files requiring special attention/action by the MSO.
Updated and maintained credentialing database as needed; scanning, copying, faxing, data entry of applications
Send out reappointment packets and follow up with the provider/practice managers until received
Released completed files to the appropriate hospital’s MSO
Data entry; create electronic files, scanning, copying, faxing
Send notices out to providers regarding approaching certifications (ACLS, BLS, PALS, ATLS, NRP, Boards)
99 Healthcare Management Dallas, TX
Credentialing Specialist 4/2015 – 5/2017
Responsible for the initial onboarding of physicians and CRNAs applying to the anesthesia group
Facilitated the application process and sent out the welcoming packets to each potential candidate
Requested credentialing packets from the hospital entities to complete for the provider
Review all returned applications for accuracy and completeness, and requested any missing information
Submitted applications to the hospitals and ASC for privileging
Follow up on missing or expired documents needed to complete the credentialing process
Applied for malpractice insurance through the company insurance agent
Maintain the physician credentialing database as needed
Coordinated with the MSO and assist with getting required information to ensure timely processing of applications and granting of privilegesManage excel spreadsheets and run credentialing reportsQuery various online entities for verification of credentials (TMB, OIG, SAMS/EPLS, NPDB, DPS, DEA, Board Certifications)Data entry of provider information into computerized database; scan and create electronic folders, faxing, copyingPg. 2
Parkland Health and Hospital System Dallas, TX
Credentialing File Auditor (contract work)) 10/2014 – 12/2014
Responsible for organizing files and performing comprehensive physician and mid-level file audits to determine if there were any discrepancies, Reconciling the file as well as ensuring the integrity and accuracy of data entered into the credentialing/privileging database.
Digestive Health Associates of Texas, P.A. Dallas, TX
Credentialing Coordinator 7/11 to 5/2014
Initiate the initial credentialing/re-credentialing process for all DHAT physicians and mid-level provider; submitted applications to the proper entity for consideration of privileges.
Cont. 2
Request checks from accounting for hospital reappointment fees, CLIA Certificates, licensures, membership fees, and maintain check request log.
Run NPDB, Licensure, OIG, AMA Profiles, EPLS, Board Certification, Medicare Opt-Out reports for DHAT’s QAC files.
Enter, track, and run CME reports to ensure DHAT providers meet requirements for state license renewals and post to spreadsheet (monthly)
Apply for TMA/TSGE membership for new physicians as needed.
Renew out of state licenses for physicians as needed.
Request Claim history from the insurance carrier and send to requesting hospitals.
Apply for TMLT/TMIC (insurance) coverage for new physicians, PAs, Nurse Practitioners, and CRNAs.
Complete all new physician paperwork and verify their credentials via the internet
Renew TMB, DPS and DEA licenses as needed via the internet
Request verification of hospital privileges from primary hospitals.
Apply for NPI numbers for new providers.
Complete and submit applications for provider’s enrollment in Medicare/Medicaid.
Request case log reports as needed for provider’s hospital reappointments.
Submit physician files to Payers for Virtual audits and pull and check file and documents for on-site file audits; participate in on-site audit results review.
Apply for and renew the provider’s CLIA certificates and submit change of address or change in directorship to CLIA for various practice locations.
Prepared monthly Medicare Opt-Out, OIG, EPLS and TMA reports. Maintained electronically as well as hard copy logs.
Followed up with hospitals on missing information needed to complete the provider’s file.
Monitored TMB news releases weekly and reviewed for list of any DHAT physicians. Reported any issues concerning DHAT physicians to Executive Director.
Applied for Supervision Prescriptive Delegation via TMB for new Physician Assistants.
Filing, scanning, copying, faxing, answer phones and other duties as assigned.
Maintain license and specialty board expirations spreadsheet.
Screened applications for completeness before submitting them to the hospitals.
Followed up with provider enrollment until provider numbers had been assigned and added to the health plans.
The Schumacher Group Dallas, TX
Sr. Medical Staff Liaison 6/08 to 7/11
Worked for a large practice management company and served as the initial point of contact for the physician recruiters in the Southwest 4 region, hospital medical staff offices, billing office, and the insurance company. I facilitated the initial credentialing and reappointment process for medical staff and mid-level providers who contracted with Schumacher client hospitals for staffing in hospital emergency departments. I presented the applications to the hospital’s MSO for consideration of privileges and initiated the provider enrollment process.
Performed background checks on new hires.
Ran queries of the state medical boards, DEA, DPS, NPDB, and various specialty boards.
Verified background, education, and experience of medical staff using on line resources and written communications.
Tracked and reported the application process to Medical Staff Offices until privileges were granted
Followed up with the Health plans regarding the status of applications until all billing numbers had been assigned.
Monitored licensure/certification and reappointment reports to ensure providers were within the hospital’s compliance
Created and set up new files on new providers entering the group.
Pinnacle Anesthesia Consultants, P.A. Dallas, TX
Credentialing Coordinator 5/05 to 5/08
Served as the point person for the physician recruiter of a large anesthesiology group and facilitated the appointment and reappointment process of the medical staff and mid-level providers applying for privileges at area hospitals. I coordinated with the insurance company to ensure that all Pinnacle providers had malpractice insurance coverage prior to working their first shift.
Maintained and updated the department’s database.; data entry, filing, copying; track expiring credentials
Reviewed applications for completeness; entered data into the credentialing database.
Mailed out application packets to the providers and followed up with them until all packets were returned.
Generated letters, reports and correspondences as needed; perform background checks on new providers
Attend new physician orientations and provided updates on the status of their application.
*REFERENCES AVAILABLE UPON REQUEST*
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