Customer Service Project Manager

Alethea Reed

Contact: 301-***-****

Email: **********@*******.***

Education: Prince George's Community College

Major: Associate of Science Degree Human Services

GPA: 3.50

Earned Credits: 70

Graduate: May 2022

University of Maryland Global Campus

Major: Psychology

GPA: 4.0

Proposed Graduation: May 2026

Professional Profile

Knowledgeable and dedicated award-winning customer service. Employee with strong written and oral communication skills. Trained and experienced in resolving customer complaints and promoting conflict resolution. Motivated to contribute to the success of the department. Strong time management and prioritization abilities.

Professional Experience

Credentials Coordinator Feb 2023-Present

Compass Government Solutions

Annapolis, Maryland

• Improved the operational performance of the credentialing system.

• Created guidelines and processes for the credentialing department.

• Worked closely with the president of the organization to provide changes in processes.

• Constructed a credentialing platform software tool Symplr Payer designed to streamline and expedite the credentialing process.

• Maintain credentials on a weekly, monthly, and yearly basis.

• Access credentialing consulting services and support for enrollment management to government contractors for the military supporting DHA and HHS.

• Research and provide quality candidates for military facilities to include background checks and

• sanctions verifications.

• Report derogatory information for expirable, and current process of applicants.

• Aide the Project Manager, Recruiter, President, and Vice President when needed.

• Managed relationships with vendors providing services related to issuance or renewal of licenses.

• Primary sources to verify and insure all licensure requirements.

• Notify and coordinate with federal and local agencies of any discrepancies regarding providers.

• Provide eligibility determinations as appropriate.

• Establish mechanisms for designating appeals. Evaluate and audit the key credentialing functions to prepare for Joint commission review.

• Submit completion of credentialing packs to the military for review.

• Responsible for the development of 13 policies, procedures and licensing programs related to security and credentialing.

• Prepared reports on licensing activities for management review.

• Investigated complaints against licensees and recommended appropriate actions based on findings.

• Collaborated with other departments to ensure proper enforcement of licensing regulations.

• Identified and reported legal violations to relevant boards or agencies to support information and evidence.

• Protected company from liability by maintaining strict compliance with TJC regulations.

• Verified work of compliance team members to keep personnel operating in line with company standards.

• Oversaw employee training on compliance strategies. Approved or denied applications based on fair and equitable criteria.

• Completed detailed reports showing evidence of compliance issues and recommending corrective actions. Rated applicants based on abilities in computer skills.

• Collected fees and filed paperwork.

• Participated in outreach efforts to educate stakeholders about licensing requirements and processes.

• Monitored changes in legislation that may affect existing licenses or create new licensing opportunities.

• Developed training materials for staff involved in administration of various licensing programs.

• Attended conferences and workshops to stay current on best practices related to licensing administration.

Senior Credentials Coordinator/HR Assistant July 2020-Feb 2023 Provizor Government Solutions

Columbia, Maryland

Clearance: Public Trust

•Direct oversight of the credentialing department with a staff of 3.

•Delivery of credentialing verification services for 30 Military bases supporting 4 branches of service.

• Ability to interpret government contracts -PWS (Performance of Work Statement).

• Involved in some aspects of contract management.

• Oversea the data integrity and functionality of credentialing while providing support to the Medical Staff and Contract Managers.

• Daily use of spreadsheets.

• Continuous communication with the recruiter to initiate the onboarding of new applicants.

• Provide orientation, education, and training to the staff regarding changes in the medical organization.

• Analyze reports to improve the latest trends in the metrics of the credentialing process.

• Provide Support to the HR staff preparing offer letters and benefit information. Achievements

• Enhanced the share drive for more accuracy and simplification.

• Created Medical Staff Bylaws and Rules and Regulations Handbook.

• Rearranged filing system to provide easy access to important documents.

• Served as a Jr. Contract Manager to assist the contract manager in managing staff, and credentialing on-boarding. Learning all aspects of contract management. Health System Specialist, Office of the Chief of Staff June 2019-July 2020 Department of Veterans Affairs Medical Center

Washington, DC

Clearance: Public Trust

• Utilizes a plethora of licensure databases such as CGFNS, NCCPA, PTCB and ECFMG to verify candidate education and/or certifications.

• Serves as liaison for administrative officers, specialty chiefs and Human Resources department to provide updates and/or gather information required to proceed with the on-boarding process.

• Review and research future employee issues using applicable laws and regulations to provide guidance on hospital hiring procedures.

• Assists new candidates with VetPro enrollment and entries.

• Manages file workload and provides updates to process stakeholders utilizing SharePoint software.

• Applies analytical/diagnostic methods and techniques to address substantive technical issues or problems characterized by controversial data collected from outside parties.

• Verifies data in VetPro utilizing secure online databases, original certified documents, and letters generated from VetPro and returned via mail, fax, or email for review.

• Performs work involving the collection, compilation, and or tracking of data in support of the credentialing and privileging program and utilizes VetPro for storage of credentials information.

• Gathers information for initial employment and/or continued employment of both licensed independent and dependent healthcare practitioners as assigned.

• Evaluates professional eligibility and qualifications of staff under VAMC's Title 38 and Hybrid Title 38 Dependent Credentialing process.

• Investigated Malpractice claims and their history.

• Process Insurance claims with several health insurance agencies.

• Investigated discrepancies utilizing a variety of methods to determine the accuracy of information by prospective candidates and their peers.

• Identifies and investigates malpractice claims and adverse actions of potential and existing members of the allied health profession.

• Determined when providers have met all requirements and maintains review authority for making referral to the Professional Standards Board.

• Serves as a resource for the credentialing process and provides education and guidance to staff that provide information relative to the program, updates and or further instructions.

• Enters and tracks data into the VetPro electronic credentials computer system. Achievements

• Developed and devised a plan for the cleanup of faculty records to include developing a system for achieving files.

• Developed online fill-in applications with digital signature.

• Assist with BlueCross Blue Shield Audit.

HR Credentialing and Compliance Specialist Jan 2019- June 2019 Reiter, Hill, Johnson & Nevin, (Consultant)

Washington, DC

• Provided a full range of administrative and supervisory duties.

• Maintained professional contacts with the different service areas within the medical center while assisting in the clarification issues and proper procedures.

• Assisted the Director of HR with performance evaluations, selection of staff recommendation of awards with minimal guidance.

• Oversight of provider enrollment.

• Utilized different problem-solving skills to analyze processes and procedures.

• Collaborate, communicate, and demonstrated customer service and interpersonal skills with all healthcare professionals to ensure quality/continuity of care and ensure compliance with established policies and regulations.

• Managed timecards using the ADP system.

• Managed different areas with unique diverse and unique functions.

• Applied well established program operations, techniques, and methods to identify and recommend solutions to problems.

• Skilled in communicating with individuals to obtain the desired effect, ensuring compliance with established policies and regulations.

• Provided briefings, orientations, staff development and training with minimal guidance.

• Analyzed and revised established program requirements, policies, and procedures.

• Assigned specific projects like analyzing program issues, organization of process, function, and process changes.

• Meet deadlines for specific projects.

• Daily setup and process of physician insurance claims for new and returning providers. Achievements

•Created monthly newsletter for the organization.

•Revamped a failing file system by reorganizing the provider share file folders.

•Introduced and implemented a new credentialing system. References Upon Request

Sr. Credentialing Coordinator Oct 2016 – Jan 2019

NuVasive Clinical Services

Columbia, MD

•Managed all aspects of technologist credentialing both internally and externally.

•Managed and supervise day to day Physician and Neurophysiology Technicians credentialing team.

•Team timecard management.

•Responsible for training and supervising new hires.

•Managed team while keeping physician credentials up to date, administered tracking, and reminder

•system.

•Provided resources for new and current credentialing staff.

•Completed technologist and clinical associate's applications for hospital privileges, work closely with

•hospital medical staff office.

•Supervised completion of OIG and SAM, and SOR checks monthly for all clinical employees bi-

•annually.

•Responsible for audit of technologist and MD files to Joint Commission standards.

•Filing; data entry, database maintenance.

•Responsible for confidential and time sensitive material.

•Knowledge of NCQA and /or Joint Commission Accreditation standards.

•Process health insurance claims for providers.

Achievements

•Initiated three key partnerships which resulted in 64% revenue growth.

•Key participated in the integration project of two companies who were bought in the last2 years.

•Saved the department thousands of dollars in wasted dollars by stopping the duplication of payments

• of three hospitals who were one in the same organization.

•Team collaboration and contributing to the creation of daily visual track and metrics for the

•department to determine issues, accountability, and work center monitoring. Sr. Credentialing Specialist Aug. 2015 – Oct. 2016 Department of Army National Guard,

(Contractor) Planned Systems International

Arlington, VA

Clearance: Public Trust

•Maintained complete and accurate provider credentialing data base CCQAS as provider information

•changed or renewed.

•Hosted weekly meetings with providers, and the leadership staff.

•Consistently met with USAP to set work standards.

•Reviewed application for completeness.

•Provided direct support to staff in administering in all aspects of processing applications and

•implementing.

•Implemented ARNG policies and standards to ensure that credentialing operations complied.

•Experienced in the DOD credentialing process.

Achievements

•Assisted in new contract negotiation which provided a renewed overview of how the new contract

•would not only save them money but help to reorganize the USANG's credentialing process.

•Participated in a collaborative effort to reconstruct the policy and procedures, providing quality

•assurance, and created bylaws for the organization.

•Re-established great relationships between the USANG to provide smooth transitions of deployment

• and a better understanding of the CCQAS system.

Sr. Credentialing Specialist II Jan 2011 – Sept 2015 Bridgepoint Hospital

Washington, DC

•Coordinated the credentialing and re-credentialing process for the facility in accordance with NCQA guidelines. _

•Coordinated the enrollment of providers in contracted managed care plans under delegated credentialing agreements.

•Monthly Agenda planning and meetings with the Medical Director and President of the hospital to review applications.

•Prepare minutes for the department of Pharmacy, Infectious Diseases, Nursing, Medical Staff and Quality Control.

Achievements

•Coordinated the merging of two credentialing systems for the integration of two facilities. This enabled physicians to maintain credentials in both facilities without the pressures of doubling up on their credentialing applications and/or serves.

•Researched and established the groundwork for new credentialing software. Spearheaded informative training classes for the medical staff supervisor and other administrative staff. Credentials Coordinator, Account Analysis Feb 2004-Jan 2011 Medstar Georgetown University Hospital

Washington, DC

•Processed and monitored the initial and renewal applications for the professional clinical staff.

•Prepared presentations to the Credentialing Committee, Medical Executive Committee, and Board for credentialing approval.

•Responsible for the monitoring of OPPE/FPPE processes.

•Functioned as a liaison, advisor and resource person for the professional staff providers, department administrators, and other hospital personnel.

•Communicated with other medical institutions and professional organizations regarding licensure, surveys, and publications and insurance claims.

•Participated in audits performed by regulatory and accrediting agencies, including Joint Commission, NCQA, DC Department of Health, and managed care organizations.

•Investigated physician malpractice claims and history. Provided interaction and assistance to all religions and ethnicity among all employees and staff. Achievements

•Trained and retrained the physicians on proper codes to be used when billing patients.

•This reduced the financial rejection report from over 400 rejections to less than 100 monthlies.

•This increased revenue for the department.

Affiliations

National Honor Society for Leadership and Success

PHI THETA KAPPA Honor Society

NAMSS Member

Secretary for the DCAMSS (District of Columbia Association of Medical Staff Services) 2013-2015 MD, DC Notary

Community Services

Patient Advocate / Sexual Assault and Domestic Violence Unit for Prince Georges Hospital Experience in planning or conducting investigations; independently interviewing witnesses or potential victims; experience in locating, collecting, and interpreting data to discover patterns of possible discriminatory activities; experience in documenting findings and preparing recommendations and correspondence; experience in writing comprehensive factual summaries; management databases; and appropriately handling sensitive information.

Grant Proposal

Prince George's Community College "Housing and Treatment for The Homeless And How It Affects Mental Illness".

Skills

MS Office, i.e. Word, Excel, and/or PowerPoint, Internet Research, Microsoft Outlook, Vet Pro, Symplr Payer & eApply Credentialing System, Priv Plus, Echo & Cactus database program, CCQAS, Delmarva. Regulatory & Accrediting Agencies (JCAHO, NCQA, Department of Health, Medicare, and other insurance entities.

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