Quality Assurance Team Member
Resume:
SUMMARY OF QUALIFICATIONS
My professional background is in organizational leadership. I provide my skills for development, evaluation of strategies, as well as implementation of programs and/or policies. I can blend my knowledge of leadership, behavior, emotional intelligence, and policy to mobilize change. 15 years’ experience in Credentialing/Compliance/Quality Assurance, with a passion for developing efficiencies. Extensive knowledge of policies and procedures including credentialing, clinical, auditing, financial, team organizational chart and workflow. I am looking for an opportunity to build cohesiveness between our internal partners to show a united front to our internal and external customers, while building confidence and success for all team members.
SKILLS
Active Listening
Approachability
Auditing
Building Effective Teams
BSA/AML
CAQH
Critical Thinking
Customer Focus
Collaboration
Communication
Contracts
Delegation Agreements
Dependability
Developing Direct Reports
Effective Communication
Emotional Intelligence
HIPPA
Joint Commission
Leadership
Management
MS Office Suite
NCQA
OSHA
Organization
Passion
PECOS
Prioritizing
Problem Solving
Quality Assurance
Strong Attention to Detail
Strong Composure
Time Management
URAC
PROFESSIONAL EXPERIENCE
People 2.0 (Remote) Pensacola FL 10/2023-Present
Credentialing & Onboarding Manager (Healthcare)
• Lead team of Credentialing and Onboarding Specialists responsible for expedient and
compliant deployment of clinical employees
• Closely monitor team productivity including technology utilized to ensure operational
efficiency
• Position People2.0 as a trusted advisor to each client. Develop and nurture strong, partner-
like business relationships with principals by demonstrating credibility, earning trust and
delivering value
• Provide support to our internal Legal department as needed for Company’s current
licensure, certification, or registration as required by state or local jurisdictions.
• Oversee the clinical and compliance aspects of implementations for new staffing and
recruiting firms coming onto the Company’s platform
• Monitor compliance with bi-annual performance evaluations, and other evaluations as
required
• Work collaboratively with the HR Department to investigate, document and provide
resolution on all clinical and professional DNRs
• Provide expertise in the development of all internal clinical training requirements, based on
state, client, and affiliate needs. For example, HIV, CPR, Vaccinations, etc.
• Provide recommendations and content for Company’s training and resource centers
• Provide expertise to the business development team in their efforts in closing healthcare
staffing agencies
• Closely monitor client operations to ensure compliance with the best practices, standards,
and procedures People2.0 has defined, particularly as they relate to hiring, employment
practices, risk management and client contracts
• Ensure internal HIPAA control measures are in place
Nursefinders (AMN Healthcare) (Remote) Pensacola, FL 01/01/2023-10/31/2023
Supervisor, Credentialing Operations
Allocate Credentialing Analyst resources to proactively address account volume fluctuations and team member schedules to optimize bookings and fill rate.
Develop and maintain relationships with outside vendors (operational, staffing, etc.) to deliver seamless customer experiences.
Monitoring assessing performance of myself, other individuals, or organizations to make improvements or take corrective action.
Co-deliver business presentations or other formal communications with Credentialing Leadership (via calls, emails, meetings) to report on progress, resolve service delivery escalations, or educate on updated processes.
Assess team member placement data in AMIE system to accelerate resolution of potential postponement or cancellation issues.
Facilitate team lead or team member problem solving on critical escalations extending beyond the bounds of established policy and procedures.
Interpret internal audits and trends following clinician file review to diagnose opportunities to improve performance or ensure compliance with external requirements (client, federal, state, Joint Commission, etc.).
Nurse Choice (AMN Healthcare) (Remote) San Diego, CA 03/01/2022-12/31/2022
Lead Credentialing Analyst
Assess team member placement data in AMIE system to accelerate resolution of potential postponement or cancellation issues.
Facilitate team lead or team member problem solving on critical escalations extending beyond the bounds of established policy and procedures.
Interpret internal audits and trends following clinician file review to diagnose opportunities to improve performance or ensure compliance with external requirements (client, federal, state, Joint Commission, etc.).
Review all incoming new client requests or contract revisions for Credentialing requirements, for assigned facilities to identify unique requirements.
Scheduling drug screens, medical requirements, completing follow up calls, reviewing documentation, etc.
Health Source Global, (AMN Healthcare) (Remote) San Diego, CA 03/01/2020-3/01/2022
Sr. Credentialing Analyst
Complete client, state, and online applications on behalf of providers’ and assist in reviewing requirements including licensure, certifications, screens, and other critical documents using the internal systems such as SharePoint, and future state will be Salesforce. These systems assist to determine healthcare professionals’ document status versus requirements needed for specific assignment to pursue outstanding requirements.
Communicate professionally in a timely manner using various mediums of communication such as email, phone, or internal communication mediums such as notes to facilitate a team approach to gathering all required documents, for example education verifications, obtaining phone and fax numbers for past work history, requesting case logs, etc.
Facilitate internal tracking system (SharePoint) to assist in the maintenance of data, building internal benchmarking and ensuring the data reflects real-time status.
Review all incoming new client requests or contract revisions for Credentialing requirements, for assigned facilities to identify unique requirements.
Scheduling drug screens, medical requirements, completing follow up calls, reviewing documentation, etc.
Health Source Global, (AMN Healthcare) (Remote) San Diego, CA 03/01/2021-7/31/2021
HSG Account Manager II
Prioritize Leads in AMIE/V2 to prospect and qualify facility clients.
Establish and cultivate long-term, effective partnerships with facility clients to gain in depth knowledge by unit and by contact of their current staffing trends, and future needs.
Document and maintain client contact information, situation, and current activity to reengage interest with each call-in order to increase the efficiency of the sales cycle.
Consult with and educate clients.
Negotiate contract terms (i.e., bill rates, other language) with client contacts and prepare new client contracts.
Contracts team to achieve divisional profit margin expectations and minimize risk.
Represent a central point of contact between facility client, HP, recruiter, and clinical liaison to effectively manage behavioral or performance challenges caused by the HP while on assignment and preserve the client relationship.
Proactively engage in cross-divisional communication to pass or receive leads which may generate new business.
Behalf Inc., (Remote) San Diego, CA 11/15/2019-11/31/2020
Compliance Manager
Assist in developing and/or performing risk assessment exercises including the federal consumer protection laws and BSA/OFAC.
Implement compliance program initiatives in the assigned business line(s), including compliance training, complaints, issue management, third party oversight and policies and procedures.
Promote compliance awareness within the business and support a culture of compliance by being a role model for the Organization values of Respect, Integrity, Service, Excellence and Stewardship.
Assist the Compliance Department’s development and maintenance of a strong compliance program and promoting a culture of compliance through strict adherence with applicable consumer protection laws and regulations.
Assess and assist in the develop action plans to address root causes.
Assist with preparation, coordination and execution of relevant regulatory examinations, audits, and regulatory action items through meeting attendance, information gathering and issue follow-up.
Assist in preparing formal reports of review findings for issuance to Senior Management and the Board.
Analyze testing results to identify trends/anomalies, provide feedback, and suggestions on potential process enhancements to improve business unit compliance
Monitor business action plans to remediate compliance deficiencies
Conducts interviews and discussions with managers at all levels to understand the Line of Business processes, guidelines, and technology platforms.
Develops and executes strategies for closing regulatory gaps.
Develops and reports findings to management regarding the status of compliance
Leads regular meetings with peers to build and maintain knowledge of current and emerging issues and risk in the environment
American Specialty Health, San Diego, CA 10/31/2018-10/31/2019
Manager, Practitioner Credentialing Administration
Manages the practitioner credentialing function for company network of practitioners, with duties including ongoing compliance, and monthly monitoring of performance.
Responsible to help maintain corporate objectives through credentialing and maintenance of the company network of practitioners
Ensuring the appropriate processes are in place to monitor and maintain systematic, timely credentialing and re-credentialing of network practitioners and providers.
Develop and implementing standards to ensure the accuracy of practitioner credentialing.
Coordinating the analysis of data relevant to the credentialing process.
Assist in preparation for state and federal audits, responding to client auditor’s inquiries and preparing responses to auditor findings.
Supervises and trains the practitioner credentialing examiners, primary verification examiners, and front-end examiners, supervisors and team leads.
Training staff with the credentialing function and acting as a resource for staff including training staff on NCQA and URAC guidelines.
Responding to non-routine and difficult credentialing issues when the staff requires assistance.
Collaborates with all levels of management across functional departments to achieve departmental goals and objectives.
Interfaces effectively with various members of management and staff to improve various processes by way of discussion, analysis, internal audit, recommendation, and implementation to assure quality.
Creates and revises credentialing policies, procedures, and workflows to ensure compliance with all regulatory accreditation, health plan delegation and contractual credentialing requirements.
Ensure the policies and procedures related to credentialing are current and reflect company and industry standards.
AMN Healthcare, San Diego, CA 12/01/2015-10/17/2018
Credentialing Supervisor
Allocate Credentialing Analyst resources to proactively address account volume fluctuations and team member schedules to optimize bookings and fill rate.
Develop and maintain relationships with outside vendors (operational, staffing, etc.) to deliver seamless customer experiences.
Monitoring assessing performance of myself, other individuals, or organizations to make improvements or take corrective action.
Co-deliver business presentations or other formal communications with Credentialing Leadership (via calls, emails, meetings) to report on progress, resolve service delivery escalations, or educate on updated processes.
Assess team member placement data in AMIE system to accelerate resolution of potential postponement or cancellation issues.
Facilitate team lead or team member problem solving on critical escalations extending beyond the bounds of established policy and procedures.
Interpret internal audits and trends following clinician file review to diagnose opportunities to improve performance or ensure compliance with external requirements (client, federal, state, Joint Commission, etc.).
AMN Healthcare San Diego, CA 3/17/2015-12/01/2015
Credentialing Analyst
Complete client, state, and online applications on behalf of providers’ and assist in reviewing requirements including licensure, certifications, screens, and other critical documents using the internal systems such as SharePoint.
Communicate professionally in a timely manner using various mediums of communication such as email, phone, or internal communication mediums such as notes to facilitate a team approach to gathering all required documents, for example education verifications, obtaining phone and fax numbers for past work history, requesting case logs, etc.
Scheduling drug screens, medical requirements, completing follow up calls, reviewing documentation, etc.
Contact this candidate