Credentialing Coordinator

Treykia Pickett

**** *. ******* ***** **. ~ Houston, Texas 77082

Phone: 281-***-**** ~ Cell: 832-***-****

***************@*****.***

Professional Profile

Education

Alief Elsik High School - 2003

Florida A&M University

Houston Community College – degree in progress

Technical Experience

Microsoft Office Suite (Word, Excel, PowerPoint, Access), LSAMS, Facets CSP, Macess, IDT, Diamond, SharePoint, CUBS, Meditech, Mekesson, EPIC, MDStaff, Cactus, Visual Cactus, Rolodex, OneApp.

Employment

01/16-Pres. Harris Health System – Ben Taub Hospital

Credentialing Coordinator

Responsible for the maintenance of provider credentialing process as it relates to initial and/or re-credentialing.

Changes in privileges/specialty or demographic information, on-going maintenance.

Verifications of current licenses, voluntary terminations, annual delegation audits, training of credentialing staff, and other duties required to maintain compliance with regulatory and accreditation agencies and credentialing policies and procedures.

Creating provider records in Cactus credentialing system.

03/14-11/15 Credentialing Specialists of America

Credentialing Coordinator Office Manager

Responsible for all activities associated with hospital privileging and payer credentialing or re-credentialing of providers.

Processing provider applications and re-applications including initial mailing, review, and loading into the database.

Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.

Renew or apply for state license, DEA, DPS, or malpractice coverage.

Creates and maintains Provider’s CAQH account.

Processes EDI and EFT for new group enrollments.

Maintains list of providers with board orders, disciplinary actions and criminal charges that will need to be disclosed with provider’s enrollments.

Process enrollments and re-enrollments for Medicare, Medicaid, and RR MCR, as well as various MCOs and commercial insurance companies.

Initiate physician background checks and NPDB queries.

Conducts audits and provides feedback to reduce errors and improve processes and performance.

Completes operational requirements by scheduling and assigning employees; following up on work results.

Keeps management informed by reviewing and analyzing special reports; summarizing information; identifying trends.

Maintains office staff by recruiting, selecting, orienting, and training employees

Maintains office staff job results by coaching, counseling, and disciplining employees; planning, monitoring, and appraising job results.

Maintains office services by organizing office operations and procedures; preparing payroll; controlling correspondence; designing filing systems; reviewing and approving supply requisitions; assigning and monitoring clerical functions.

12/10 – 01/14 UnitedHealthcare

WAH Sr. CCP Team Lead

Responsible for answering incoming calls from customers while ensuring a high level of customer service and maximizing productivity in an inbound customer call center environment for the states of Arizona, Maryland, Michigan, New York and New Jersey for Medicaid and Medicare products.

Assist consumers with resolution to questions or concerns regarding their Medicaid healthcare benefits coverage, prescriptions, benefit and eligibility, billing and payment issues, customer material requests, physician assignments, authorization for treatment and Explanation of Benefits (EOB).

Initiate member appeal or complaint process. Research and Investigate appeals and/or grievances Meeting monthly statistical metrics set forth by company (Quality, Adherence, AHT)

Locate pharmacy authorizations.

Quality assurance/call auditing

Assist CRG research department with processing of Florida returned mail.

Communicate with other health related agencies and organizations as needed.

Cross trained to provide back up support for other customer service representatives when needed.

2012/2014 New Hire Training Coach

Facets CSP Maryland and Washington Health Plan

Traveled to Overland Park, KS – Facets CSP Kansas New Hire Class

Responsible for all aspects of quality assurance

Complete weekly and monthly quality evaluations via live call or Qfinity

Monitor calls, coach and barge calls as necessary

Mentor and train individuals daily

Ensure CCP’s are using the appropriate SOP’s to service each call

05/07 - 12/10 Litton Loan Servicing LP

Loan Coordinator-Loss Mitigation

Handle Residential and Commercial products which are current to 60+ days past due in order to control delinquencies and prevent foreclosures.

Maintain accurate collection records using Radar to document telephone customer contacts to collect monies due on delinquent mortgages.

Counsel homeowners about different programs or outside organizations who can assist them when their income has decreased dramatically.

Analyze borrower’s financial situation to determine the best options to cure delinquency.

Advise mortgagors on programs that can be used to avoid foreclosure, such as deed in lieu, pre-foreclosure sales (short sales), loan modifications, or selling of the property on a refinance.

When necessary initiate Loss Mitigation process to modify loan to avoid loss of the property.

Place the borrower on forbearance/repayment plan agreements to resolve the delinquent months owed over a period of time.

Responsible for posting cash and credit payments for all payers

Performed special projects assigned by management team to ensure end of month goals are met.

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