Medical Staff Credentialing / Administrative Assistant

Velma Wickenhofer ***** Country Canyon San Antonio, TX 78252 210-***-**** Home

210-***-**** Cell

Professional Profile: Motivated individual looking to utilize my skills and experience in a business environment.

Employment History:

University Health System – San Antonio

Manager, Professional Staff Services, 05/2013-04/2016

Provided direct support to Director of Medical Staff Services

Oversaw the daily operations of the processing of initial and re-credentialing of faculty provider applications

Delegating responsibilities to employees in order to complete tasks and/or deadlines

Data Entry of application information, corrections or modifications

Counsel employees when required due to performance issues

Provided performance annual evaluations for employees

Updated PeopleSoft system weekly in order to track employees hours worked

Reviewed and updated processes in order to streamline work to minimize duplication, increase productivity and time management

When needed assumed responsibilities of processing credentialing applications for Community Medicine Associates for approximately 1 yr and achieved 100% audit scores

Assisted applicants with completing applications to ensure applications and documentation were complete and submitted in a timely manner

Ensured applications presented to monthly Credentials Committee were in compliance with Joint Commission Standards as well as with company policies

Planned and organized the Annual Doctor’s Day Event for approximately 1200 physicians at 3 different locations

Maintained filing project to ensure files and documentation were kept up to date with current information.

Reviewed reports to ensure staff maintained a 30 day turnaround time on completing applications in order to remain in compliance with delegated credentialing contracts.

Ensure files processed by staff met all regulatory requirements and standards by conducting random audits

Performed monthly audits on processed application and provided billing reports and invoices to delegated companies for services rendered

Baptist Health System – San Antonio

Initial Credentialing Specialist, 10/2005 – 05/2013

Process Initial credentialing applications for physicians and allied health professionals in the San Antonio and surrounding area in order to maintain admitting privileges within the Baptist Health System

Fax and/or email initial credentialing application packets to interested applicants to prevent delay of postal service and expense to company

Data Entry of application information to the appropriate databases

Fax, email or mail verification letters to facilities and individuals

Verify Medical, DEA and DPS licenses either on-line or by phone

Obtain verifications for the following: board certification, education, education commission of foreign medical graduates, active and previous hospital privileges and the national practitioner data bank using applicable websites.

Ensure applicants have completed the required education and obtained the required licensure to see patients within their specialty

Review malpractice claims through insurance carriers

Review sanctions through the Texas State Board of Medical Examiners, Office of Personnel Management and Medicare/Medicaid Board

Ensure applications processed and submitted to committee and governing body are complete and meet regulatory standards and company policies

Provide support to Director of Medical Staff Services and the Interim Director on special projects and surveys

Methodist Healthcare System –

San Antonio

Credentialing Specialist, 05/2000 to 10/2005

Initial credentialing for physicians and allied health professionals in the San Antonio and surrounding area in order to maintain admitting privileges within the Methodist Health System

Mailed initial credentialing application packets to interested applicants

Data Enter application information to the appropriate database

Fax, email or mail verification letters to facilities and individuals

Verified Medical, DEA and DPS licenses either on-line or by phone

Obtain verification of the following: board certification, education, education commission of foreign medical graduates, active and previous hospital privileges and the national practitioner data bank using applicable websites.

Ensure applicants have completed the required education and obtained the required licensure to see patients within their specialty Review malpractice claims through insurance carriers

Review sanctions through the Texas State Board of Medical Examiners, Office of Personnel Management and Medicare/Medicaid Board

Ensure applications processed meet regulatory standards and company policies

ETHIX Southwest I Aetna- San Antonio

Credentialing Specialist I Project Coordinator, 11/1998 to 08/1999

Credentialing and Re-credentialing of Physicians for the San Antonio area

Data Entry, Running Reports, Maintaining current physician records, request Office Site Visits and Re-credentialing Performance Profiles, Request any missing information or documentation on physician applications

Verified Medical, DEA and DPS state licenses, board certification, education history, education commission of foreign medical graduates, active and previous hospital privileges and the national practitioner data bank using applicable websites. Obtaining this information will confirm that applicants are qualified individuals to treat patients within the health plan

Review of malpractice claims and sanctions through the Texas State Board of Medical Examiners, Office of Personnel Management and Medicare/Medicaid Board, submit files to Physician Advisory Committee.

Minimal experience with delegated credentialing.

PacifiCare of Texas- San Antonio Credentialing Specialist, 10/1995 to 10/1998 Same duties as outlined as ETHIX Southwest

Education:

South San West Campus High School - 1993

Vocation Classes in Business Administration

February 2015 – December 2015

Attended and Completed a Management Training Academy provided directly through University Health System

Volunteer:

Southwest High School Band Booster President 2015- Present

Assist the Fine Arts Department / Marching Band Directors with concession sales, fundraisers, events, in-town and out-of-town games, chaperones, field trips, etc.

Verify with Board Treasure cash withdrawn from bank account for concession stand sales, balance cash drawer for all cashiers working on game night for bank deposit

Skills:

Bilingual

Excellent organizational, oral and written skills

Excellent Telephone etiquette

Type 51 words per minute

10 Key by Touch

Knowledge with Windows, Microsoft Word, Excel, MSOW, ECHO,

Team Player

Work well under pressure and with set deadlines

Dedicated/Motivated individual

Fast learner

Has great attention to detail and accuracy

Ability to multitask

Knowledge of TJC and NCQA standards.

Experience working on Lean Process

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