Credentialing Director Healthcare Compliance Leader
Resume:
Dorothy Pritchard
New Castle, DE *****
**********@*****.***
Professional Summary
Detail orientated effective professional with a proven history of developing customer loyalty and doing what is right for the customer and the business.
Willing to relocate: Anywhere
Authorized to work in the US for any employer
Work Experience
Credentialing Director
RL Health Inc. dba The Medical Center at Woods-Langhorne, PA November 2023 to Present
• Manage the credentialing process for a team of 20+ healthcare professionals, ensuring compliance with industry standards and regulations.
• Collaborate with HR department to verify credentials and qualifications of potential hires, ensuring only qualified candidates were considered for employment.
• Maintain accurate records of all staff credentials, licenses, certifications, and continuing education requirements
• Conduct regular audits to ensure ongoing compliance with accrediting bodies' standards and requirements.
• Served as a liaison between healthcare providers and insurance companies to resolve any credentialing issues or discrepancies.
• Review applications for completeness and accuracy, following up with applicants as needed to gather missing information or clarify details.
• Closely monitor expiration dates of licenses, certifications, malpractice insurance policies, etc., sending timely reminders for renewal or updating as required.
• Leverage technology tools such as CAQH ProView or similar systems for efficient data collection during the provider enrollment process.
• Spearhead efforts to standardize internal processes related to provider enrollment across multiple locations within the organization.
• Liaise with external auditors during accreditation surveys or audits related to provider enrollment processes.
• Serve as a subject matter expert on all matters related to provider enrollment processes during internal meetings or cross-functional projects.
• Maintain strong relationships with external agencies such as state licensing boards and professional associations to stay updated on changes in regulations or requirements. Administrative Coordinator/Credentialing Specialist Public Health Management Corporation-Philadelphia, PA May 2015 to November 2023
• Responsible for managing the onboarding process or prospective provider candidates to ensure accurate and timely completion of applications, and required documentation necessary for credentialing.
• Ensured timely correspondence with Revenue Cycle Team.
• Provided documentation for payer requests to assist Account manager with prompt and timely payment.
• Facilitated ongoing dialogue regarding insurance issues and guidelines with Revenue cycle Management Team, and Senior Management Team.
• Audited provider files to ensure compliance with HR and regulatory standards.
• Understood and adhered to compliance standards, federal, state, regulations, laws, policies. Comply with HIPAA and Department of Public Health, Joint Commission and other accreditation and regulatory agencies standards.
• Knowledge and adherence to Infection Control and Environment of Care Guidelines. Administrative duties as assigned.
Customer Service Supervisor
Delaware Industries for the Blind-New Castle, DE
April 2012 to April 2015
• Supervised the Customer Service Personnel of 7 or more.
• Maintained smooth flow of Custom Product orders, quality control and coordination with the Fiscal Department. Maintain customer satisfaction.
• Reviewed and assisted in the resolution of customer complaints.
• Assured prompt and accurate delivery of ordered items.
• Conducted weekly meetings with Customer Service Representatives to discuss and review pending orders and/or complaints.
• Job function also included but not limited to payroll, negotiating pricing with vendors, touring potential customers and sales.
Head Teacher/Facilities Coordinator
Academy for Creative Enrichment/Creative Learning Academy-Bear, DE August 1996 to March 2012
• Managed the front office of primary and preschool. Guided present and potential families through the School Program.
• Insured that policies and procedures were followed.
• Made arrangements for teachers, enrolled families, vendors, etc.
• Assured that the facility ran efficiently through scheduling customer service and troubleshooting. Supervised support staff.
Retention Credit Analyst
Bank of America-Newark, DE
August 2007 to July 2009
• Provided accurate, timely decisions to improve customer relationships as well as promote business growth.
• Conducted rate reviews and retained balances and relationships to ensure profitability. After School Director
Madison Park Community Center-Roxbury, MA
January 2005 to June 2005
• Developed and maintained educational programming and ongoing day to day operations of the After School Program.
• Worked with staff and volunteers to develop effective learning strategies.
• Oversaw planning and implementation of program schedules.
• Hosted staff meetings. Developed and maintained all reports.
• Recruited and hired staff. Managed and provided guidance to program staff to ensure curriculum and activities.
Owner/Director
Creative Babies-Bear, DE
August 2002 to July 2003
• Owned and Operated an Early Childhood program for infants and toddlers.
• Implemented and executed the academic program.
• Developed policies and procedures for families.
• Managed all financial and personal aspects of the business. Senior Credit Analyst
American Express Centurion Bank-Wilmington, DE
July 1989 to July 1996
• Reviewed and finalized credit applications.
• Resolved credit disputes and helped customers navigate through their statements. Education
Northeastern University - Boston, MA
January 1986 to December 1989
Christ the King Regional High School - Brooklyn, NY January 1982 to December 1986
Skills
• Extensive knowledge and experience in the Customer Service, Banking, and Credentialing field.
• Administration
• Organizational skills
• Medical terminology
• Familiar with Microsoft Outlook, Word, Smartsheet, and Excel.
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