Kristin E. Landrum

*** ****** **., ***. *

Colorado Springs, CO 80911

512-***-**** cell

adsuhb@r.postjobfree.com

Credentialing Coordinator/Administrative/Provider Enrollment

Detail oriented and quality focused professional trained in medical network development, credentialing, and quality support. Successful track record of handling complicated assignments and administrative requests. Offer solid foundation in software applications, database management, and data entry; proven ability to readily master new technology. I am dedicated to maintaining a strict code of confidentiality.

Key Administration Skills

• Hospital, Payer, & Practice Credentialing

NPPES & CAQH

• CIHQ, URAC, CAQH, CPT, HCPS, REVCodes

• NCQA Guidelines

URAC Guidelines

Provider Enrollment & Demographic Changes

• CMS

• Medical Terminology

• Medical Insurance

MDStaff, MODIO, Intellicred, Bull Horn, PECOS, and ATHENA as well as other programs

Type standing orders and have them approved.

• Administrative Support to the Medical Director, Chief of Staff, and CEO

• Provider and Facility Contracting

• The Joint Commission

Departmental Meeting Officiate while taking minutes.

Professional Experience

Diversus Health Services 01/2022–Present

Credentialing Specialist

My credentialing duties include processing initial and recredentialing applications for a wide variety of providers.

Diversus Health is a Behavioral Health Practice with 13 locations for credentialing providers.

Some of my other duties include ensuring licenses, DEA, Malpractice Insurance does not expire.

Another duty is to update CAQH, NPPES and I&A

Correspond with providers regarding their initial applications and recredentialing applications.

I also perform data entry for application processing. The credentialing software used is MODIO.

Southern Colorado Clinic, PC 05/2021– 01/2022

Credentialing Specialist; Changed positions due to commute

My credentialing duties include preparing appointment and reappointment applications for local hospital. I also assume all responsibilities having to do with Provider Enrollment and Provider Demographic Update Changes. While working with the health insurance contacts, I have grown to have a mutual relationship in order to correctly make provider/group changes.

As the primary Credentialing Specialist and Provider Enrollment Coordinator I have been able to take on and facilitate new tasks. I feel this has been a wonderful growth opportunity in my career.

Integrity Locums – Centennial, CO Contract Role 10/2019 – 01/2020

Credentialing Coordinator

Processed and completed credentialing applications, to include initial, recredentialing, Payer, and facility applications.

Ran verifications for all new and recredentialing applications.

Provided both external and internal customer service to include communication with medical providers.

Assisted Client Representatives to ensure their providers sent needed credentialing documents and the provider would be fully credentialed before their position start date.

Specialist Telemed April 2019 – August 2019

Licensing and Credentialing Specialist – Consulting Position from home

While working in many various states, I have become proficient in helping to obtain a provider’s license quickly and efficiently.

My position was to walk the new physicians through the licensing and credentialing processes while also assisting the physician with obtaining necessary documentation.

Once the physicians have a license issued, I then take the appropriate steps to ensure that they have a DEA and Controlled Substance Registrations issued to them in each state.

During the licensing process, I began all the applications for hospital privileges so that they physician may provide consults.

Initial Appointment Applications and Recredentialing applications were processed prior to deadline.

Radiology Partners – Houston, TX 06/2018 –09/2018

Credentialing Verifications Specialist

As the Credentialing Verifications Specialist, I credentialed physicians for the practice. The practice is Joint Commission Certified. I was the first employee hired to this new department.

My job tasks include initial and recredentialing of the physicians employed with Radiology Partners. There are almost 1,000 physicians on staff.

Cornerstone Hospital of Austin, TX 09/2014–09/2017

Medical Staff Credentialing Coordinator

I managed the Medical Staff Office along with all related credentialing and medical staff activities.

One of my duties was to assist in composing policies and procedures for the department as well as have them approved for addition to the proper manuals or By-laws.

Another duty that I preformed was to assist in implementing a 24-hour Physician Assistant/Nurse Practitioner Program for the hospital. Extensive research was required for this project as well as preparing policies, procedures, and delineation of privileges that must have been approved by all Executive and Governing Bodies.

While I was with the hospital as the only Credentialing Employee, the facility decided to change from Joint Commission Accreditation to CIHQ Accreditation. I was instrumental in preparing for a corporate pre-audit as well as the CIHQ. The hospital earned their accreditation.

Some of my other duties included processing initial and re-credentialing applications, preparing for the Medical Executive Meetings and Governing Board Meetings. Making sure that any documents needing to be presented were distributed for voting. Software used was MDStaff.

NeuroAustin Neurology Associates, Austin, TX 12/2012 –11/2013

Credentialing Manager/Contracting – Consulting Position

Performed the credentialing for hospital privileges and insurance networks for a physician starting her own practice.

Negotiate and execute medical insurance contracts on behalf of the physician.

Austin Surgical Hospital, Austin, TX 08/2011 –08/2013

Credentialer – PRN Position

I performed the credentialing, appointment, and reappointment processes of each physician or allied health applicant on staff or applying I Maintained confidential credential files on all members of the medical staff, including current staff status, current licensure, and other certifications, as well as clinical privileges.

Coventry Healthcare/Mental Health Network, Austin, TX 03/2008 –03/2010

Network Development Representative/Provider Contracting Coordinator

• Provided administrative support to the VP of Provider Services.

• Performed recruitment and development of behavioral health provider networks to include hospitals, group practices, and individual practitioners.

• Performed hospital/facility contracting.

- Negotiated per diem rates and contract language within limits set by the COO and/or VP of Provider Services.

- Composed contract language for new agreements and contract amendments.

Performed credentialing of newly contracted providers.

• Evaluated the adequacy of provider network and availability of providers in a defined area for possible recruitment.

- Coordinated and scheduled meetings with practitioners and facilities to conduct contracting and recruitment discussions. Travel required.

- Created weekly status reports to communicate status and progress of development efforts and projections for completion date.

• Assisted department customers in the following areas:

- Conflict resolution,

- claims research, negotiations, and

- coding issues.

Bon Secours DePaul Medical Center, Norfolk, VA 03/2005 –12/2006

Credentialing Specialist

• Provided administrative support to the VP of Medical Affairs and medical staff.

- Performed credentialing and recredentialing verifications in compliance with Joint Commission standards and state/federal laws.

- Maintained credentialing schedules to assure required deadlines were met.

- Responsible for taking accurate meeting minutes and approval the minutes from the appropriate department chair.

Baptist St. Anthony Hospital, Amarillo, TX 09/2000 – 09/2011

Credentialing Assistant

• Provided credentialing assistance to the Director of Medical Staff Services.

• Performed credentialing verification in compliance with Joint Commission standards, Medical/Dental Staff Constitution, Medical/Dental Staff Policies and Procedures, Hospital Policies and Procedures, and state/federal laws.

• Maintained credentialing schedules to assure required “need by dates” were met.

• Participated in internal and external audits of medical staff credentials.

• Verified privilege delineation and staff status to other hospitals and facilities.

• Responsible for operational administration such as mail distribution, supply orders and printing orders.

Eastern Virginia Medical School, Norfolk, VA 08/1999 –05/2000

Administrative Assistant

• Provided administrative support to the Medical Director.

• Responsible for generating accurate technical reports for information transfer.

• Scheduled procedures and surgeries.

• Responsible for operational administration such as bookkeeping, inventory tracking, customer billing, supply orders, and deliveries.

Education/Professional Development

Ombudsman of the year for the USS Elrod FFG -55 stationed out of Norfolk, VA

Held a position on Yorktown Naval Weapons station which included a government clearance

Tidewater Community College, Norfolk, Virginia, Undergraduate Studies

Amarillo College, Amarillo, TX Undergraduate Studies

Currently studying for the National Association of Medical Staff Services exam to gain certification for:

Certified Professional Credentialing Specialist (CPCS)

Contact this candidate