Credentialing

Tina Anderson

***** * **** **, **, Galesville, WI 54630 715-***-****

*************@****.*** https://www.linkedin.com/in/tinalanderson Experience

**/**** – Present Credentialing Specialist, OakLeaf Medical Network Eau Claire, WI

• Timely entry, processing, and tracking of enrollment/re-enrollment files, ensuring proper payment

• Maintain confidential enrollment files in electronic credentialing database

• Review credentialing files for accuracy and completeness

• Monitor status of payer credentialing applications and perform follow-up as necessary

• Develop and maintain provider rosters to comply with various contracting services and requirements

• Prepare initial credentialing and re-credentialing files for review by the CSC Committee

• Monitor and maintain Participation Grid for practice members

• Complete necessary monthly, quarterly and annual reports

• Communicate payment, policy, or procedural information from the payors to member clinics

• Serve as liaison between OLMN clinics and payers to resolve provider enrollment and payment issues

• Special projects, as needed

01/2019 – 03/2025 Reyes Holdings La Crosse, WI

10/21 – 03/2025 Disability Case Manager II – East Region Virtual

• Administer and manage leave programs, including short term disability and maternity, with FMLA

• Collect records and file all necessary documents electronically in a timely manner

• Communicate with, and train, BU HC teams and employees about leave program

• Complete processing of Worker Compensation for assigned East Region

• Assist with coverage of East & West Region

08/20 – 10/2021 Leave Administrator II – East Region Virtual

• Administer and manage leave programs, including updating and improving system

• Collect records and file all necessary documents electronically in a timely manner

• Communicate with BU HC teams and employees about leave program

• Complete processing of Worker Compensation for assigned East Region

• Assist with coverage of East & West Region

01/19 – 08/2020 Leave Administrator I – California

• Administer and manage leave programs, including updating and improving system

• Collect records and file all necessary documents electronically in a timely manner

• Communicate with BU HC and employees about leave program

• Primary focus on California leaves related to both Federal and State

• Complete processing of Worker Compensation and Military leaves for California and Midwest territory

• Assist with coverage of Midwest territory

08/2012 – 09/2018 Conduent (formerly Xerox Business Services) Florham Park, NJ 12/16 – 09/18 Managed Care Compliance Manager, Worker Compensation Analyst Virtual

• Prepare certification renewals, and required modifications to Managed Care filings

• Manage new certifications, renewals, required mailings, reporting requirements, data calls, etc

• Track changes to applicable laws, regulations, and jurisdictional requirements

• Proactively communicate requirements, deadlines, filing needs, and other concerns

• Participate in coordinating state audit procedures for case management and/or medical bill review

• Assist the VP, Partner Relations with various network analyses

• Ensure compliance management for all Conduent state managed care plans 08/12 – 12/16 Service Delivery Supervisor, Transaction Processing Arkansas City, KS

(contracted services to support GE Aviation)

Client Focus:

• Support services for Aviation Industry Client at two, (2), locations via interaction with Client Managers

• Determine needs, solicit feedback and implement solutions to address Client issues

• Analyze workflow and assignments to ensure operations run efficiently

• Identify process improvements, drive execution, utilizing metrics and quality functions

• Establish work schedules to minimize overtime

HR/Team Focus:

• Coach and Mentor to a team of 35+, including Goal Setting and Career Development Planning

• Annual Reviews and Performance Improvement Plans

• Staffing – Interview/Selection/Placement, Onboarding/Orientation, and Training

• Process payroll and track PTO

General Management Focus:

• Project Management

• Procedure and Policy – Development and Implementation

• Metrics and Quality – Lean Six Sigma Yellow Belt 05/12 – 12/12 Provider Credentialing Project Manager, Independent Contractor Virtual

• Create/Update/Maintain provider CAQH profiles

• Apply for Medicare and/or Medicaid numbers

• Payor Credentialing & Re-credentialing for all provider applications*

* For multiple payors such as Blue Cross, HealthPartners, Medica, Medicare & State plans. 02/12 – 08/12 Compliance Audit Coordinator, Stillwater Medical Center Stillwater, OK

• Expedite responses to government audit requests related to RAC, MAC, MIC, CERT, etc

• Perform quality control audits of scanned patient records during facility transition to EHR

• Created tracking and metrics system related to audit requests, decisions, and success rates

• Audit hospital admitted patient records for required documentation for all verbal & telephone orders 10/08 – 02/12 HSHS Western Division: Sacred Heart & St. Joseph’s Hospital Eau Claire, WI 11/10 – 02/12 Payor Credentialing Specialist

• Creating/Updating/Maintaining CAQH profiles

• Applying for Medicare and/or Medicaid numbers

• Project Management – Policy/Procedures

• Payor Credentialing & Re-credentialing for providers and facilities, including clinics and hospitals*

* Includes all provider types; * For multiple major carriers including Medicare & State plans 10/08 – 08/11 Appointment Coordinator/Secretary – Occupational Health

• Support Regional Director, Medical Director with administrative items

• Provide excellent service to injured employees and employers

• Medical records, billing, appointment coordination

• Practice & Project Management

Completed duties for both positions from November 2010 – August 2011, until workload for PCS role grew to full time. ACS role was also full time during entire length of service. 05/07 – 10/08 Technical Customer Service Representative, Vertafore (formerly FISERV) Eleva, WI

• Provide excellent software support service to insurance agencies and their agents

• Troubleshoot insurance rating software issues quickly and efficiently

• Enthusiastically working as part of a team to provide the best service possible 09/06 – 07/07 Senior Leave of Absence Specialist, Target – Corp. Brooklyn Park, MN

• Accurately assist Target team members with all leave of absence issues nationwide

• FMLA, Short/Long Term Disability & Worker Compensation benefits/laws for all 50 States

• Document data accurately and in detail

01/06 – 09/06 HR Coordinator / Home Health Supervisor, Mary T, Inc. Coon Rapids, MN

• Re-vamp paper-filing system for personnel files

• Facilitate & coordinate compliance related training

• Developed On-Call Networking Pool to fill urgent shift openings

• HR& Generalist duties: new hires, discipline, termination, benefits, payroll, compliance tracking

• Supervision of On-Call Pool and 30+ PCA's – includes scheduling and supervisory duties 09/03 – 09/05 Executive Assistant/HR Manager, Family Life Mental Health Center Coon Rapids, MN

• Procedure development for several key office positions

• Develop filing system for personnel & credentialing files

• Worked w/insurance broker to save 10% on health insurance benefits to clinic employees

• Assist Executive Director with letters, memos, meeting minutes, etc

• Board meeting preparation, mailings, communication

• HR: new hires, discipline, training, terms, insurance, payroll

• Credentialing of practitioners for multiple commercial carriers, Medicare & Medicaid

• Fundraising and grant writing/seeking

Education

12/2011 Globe University Richfield, MN

Bachelor: Healthcare Management Graduated with Honors – GPA 3.63/4.0 1994 Western WI Technical College La Crosse, WI

Certificate: Office Computer Specialist, with Academic Honors 2013/14 Wichita State University Wichita, KS

Certificate: Leading Teams to High Performance

Certificate: Improving Supervisory Skills

2013 Xerox Business Services, LLC. Arkansas City, KS Yellow Belt – Six Sigma – Qwik Solver (proprietary training)

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