Credentialing Specialist

Emilee Langer

Emilee Langer, MPH

Parker, CO 814-***-**** linkedin.com/in/emilee-langer-weis ************@*****.*** PROFESSIONAL PROFILE

Health Care leader known for business development, and management, quality improvement and operational excellence in both for-profit and not-for-profit sectors. A dedicated team builder, driven by natural curiosity- empowering solutions and turning vision into action.

SKILLS

Credentialing / Re-credentialing Account/Vendor Relationship Management Process and Quality Improvement Staff Recruitment and Development Grant Procurement and Management Human Resource Management EXPERIENCE

The Judge Group

UCHealth Plan Administrators-Lone Tree, CO (contract) February 2020-present Credentialing Coordinator

Prepared credentialing applications for committee review and approval, primary source verification, license actions and supporting documentation and adhered to NCQA guidelines for credentialing. Reduced backlog 50% during contracted employment

Participated in committee meetings

Updated internal systems

Mid-Atlantic Dental Partners Denver, CO November 2018-February 2020 Revenue Cycle Credentialing Manager

Led credentialing and payer relations nationwide in 7 states, 85 practices and 145 dentists.

Managed payer relations and enrollment process for new and re-credentialed providers, and improved turnaround time from 6 months to less than 45 days.

Conducted regular audit and managed expiring credentials (licenses, DEA, Malpractice) and updated payers to avoid contract cancellations.

Evaluated new practice affiliation needs and completed TIN, NPI and contract changes to ensure uninterrupted service for existing patients.

Developed payer fee matrix for all locations to ensure best practices across commercial markets. Delta Dental of Colorado Denver, CO August 2017-August 2018 Director, Clinical Management

Installed automated claim review software resulting in $50K in monthly savings, reduced claim inventory and improved turnaround time by 50%.

Developed quality improvement strategy for outlier identification and inter-rater reliability training for professional consultants.

Automated credentialing process and reduced application turnaround time to less than 20 days. Executed CDT terminology and coding education modules for internal staff and network providers. Supported sales and client services in clinical presentations, wellness fairs and other Community Education initiatives. Led a pilot program for Hypertension Identification in partnership with the University of Colorado Health system. Coordinated patient referrals for health interventions through early identification of hypertensive crisis. Hometown Health - Reno, NV June 2015 – August 2017 Manager, Strategic Planning and Product Development Led planning and development for Medicare Advantage products and final bid submission to Medicare. Improved revenue results from a $7M loss to a net gain of $3M over two years. Achieved a Medicare 4 -Star rating for service and compliance on HMO products. Wrote RFPs, and implemented new product strategies for dental, vision and hearing services valued at more than

$30M. Collaborated with internal and external Senior Leaders and associate general counsel to evaluate risk assessments, negotiate contracts, and developed and implemented Key Performance Indicators (KPI) to ensure compliance with URAC accreditation standards.

Led cross-functional teams in continuous improvement and reduced new account set up time from 3 months to 30 days.

Emilee Langer

Member of the Policy and Procedure, Compliance, Delegation and Oversight Committees. Emilee Langer

Custom Tool and Design, Inc., Erie, PA Oct 2013 – Dec 2015 Human Resources Manager

Recruited staff in Sales, Engineering, Tool and Die Journeymen, and clerical positions. Analyzed employee compensation and benefits packages to ensure competitive offers to new hires. Managed compliance with state and federal mandates for the ACA, worker’s compensation, unemployment compensation and 401K plans.

Negotiated insurance renewals for health, dental and vision, and achieved 20% savings. Managed third-party contracts for property /casualty insurance resulting in 40% savings, and improved disaster recovery funding.

Managed payroll, accounts receivable and accounts payable, wrote employee handbook, and re-engineered performance management and appraisal process for all positions. Led safety training and compliance for OSHA and NTMA. Prepared responses to RFPs, reviewed CAD and engineering drawings, and submitted requests for third-party subcontracted components for molds.

The Salvation Army Dental Center, Oil City, PA May 2009 – March 2013

Divisional Dental Director

Developed business plan for a four-chair dental clinic serving low-income people in a designated health professional shortage area in western Pennsylvania.

Awarded start up grants totaling $650,000, and managed reporting to grantors, Salvation Army leaders and the Pennsylvania Department of Welfare - Medicaid.

Led facility construction, equipment purchasing, supply chain contract negotiation, hardware and clinical practice management software purchase and installation.

Recruited dentists, hygienists, assistants and office personnel. Wrote job descriptions and performance management protocol, completed on-boarding for all positions. Led day to day operations including revenue cycle management, collections and reporting.

Increased access to dental care for 200 patients per week, and generated revenues of $2M annually. Educated leaders of head start, pre-school and high schools in two counties as well as K-12 students on the importance of oral health using Healthy Teeth, Healthy Kids curriculum. Served as a member of a state-wide task force, and an invited speaker at local, state and national organizations on facility capabilities.

ADDITIONAL EXPERIENCE

Pine Grove Ambulatory Surgery Center, Russell, PA – Executive Director Special Smiles, LTD, Philadelphia PA– Executive Director United HealthCare–Dental Benefit Providers, Bethesda, MD – National Account Executive CIGNA Chicago, IL – Senior Client Manager

CIGNA Philadelphia, PA – Group Benefit Specialist, Assistant Claim Manager EDUCATION

Master of Public Health (MPH), Public Health

Drexel University, Dornsife School of Public Health, Philadelphia, PA Bachelor of Science (BS), Psychology

University of Pittsburgh, Pittsburgh, PA

COMMUNITY LEADERSHIP

Mile High United Way- Women United- Annual Luncheon Committee Member Leadership Reno-Sparks-Reno Chamber of Commerce

Boy Scouts of America - Lifesaving Award Recipient – Celtic Cross Award Recipient First Presbyterian Church of Titusville - Board of Directors (Elder) Titusville YMCA - Board of Directors, Personnel Committee CONTACT INFORMATION

Emilee Langer 814-***-**** (cell)

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

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