Continuous Improvement Provider Enrollment

Alvis Locks

Pearland, TX 832-***-**** **********@*********.***

Credentialing Specialist Provider Contract Coordinator Credentialing & Privileging Contract Management Audit & Healthcare Compliance Data-driven credentialing professional with 20+ years of experience optimizing provider enrollment, credentialing, contract negotiation, and compliance processes, driving operational efficiency within healthcare administration. Ensured accurate credential verification for healthcare providers, coordinated with insurers and regulatory bodies to resolve discrepancies, and supported timely contract execution, using credentialing software. Streamlined credentialing workflows, enhanced data integrity, and led audit initiatives to guarantee organizational compliance with NCQA, CMS, and other regulatory standards. Advocating for continuous improvement methodologies to enhance operational performance and service delivery. Key Highlights

• Oversaw the full cycle of credentialing and re-credentialing processes, while ensuring adherence to industry regulations and standards, such as NCQA, CMS, and TJC and proactively addressing gaps, guaranteeing 100% compliance during audits.

• Extensive experience managing provider contracts, conducting primary source verifications, and streamlining contract administration processes to enhance operational efficiency. Core Competencies

Delegated Credentialing & Re-Credentialing Provider Enrollment Processes Primary Source Verification NCQA, CMS, and TJC Standards Compliance Quality Assurance (QA) Data Integrity & Accuracy Document Verification & Reporting Payer Policy Negotiations Risk Management Medical Terminology Healthcare & Regulatory Knowledge File & Database Management Data Visualization Cross-Functional Collaborations Continuous Improvement & Learning Legislative Research & Policy Updates Technical Skills: Credentialing Software: CACTUS, MDStaff, Credential Stream, CAQH, Intellicred, and Verification Tools for DEA, State License, NPI, Medicare Opt-Out, Education, Specialty Boards, PECOS and Insurance Standards & Regulatory Compliance: NCQA, CMS, Joint Commission Accreditation Standards (TJC), HIPAA, URAC, AAAHC and DNV Productivity: MS Office 365, Zoom, Slack, Google Workspace

PROFESSIONAL EXPERIENCE

Veaux Professional Service Houston, TX (Hybrid)

HR Recruiter & Onboarding Specialist Feb 2023 –Present Hired and onboarded new talent by conducting comprehensive interviews, implementing targeted recruitment strategies, and utilizing advanced sourcing techniques to ensure cultural and skillset fit.

• Designed and executed comprehensive onboarding programs to enhance new employee engagement with company values.

• Cultivated and maintained candidate relationships by regularly communicating job updates, offering personalized feedback, and providing ongoing career development support.

• Collaborated with cross-functional departmental leaders to develop tailored training content with role-specific skillset.

• Lowered turnaround time by 30% and improved credentialing process through the implementation of a new tracking system.

• Reduced onboarding time and boosted team productivity by formulating new hires training programs and onboarding workflows. Andros Technologies New York, NY (Remote)

Compliance & Audit Coordinator Oct 2022 – Feb 2023

• Reinforced adherence to regulatory and policy requirements across the organization by leading compliance audit initiatives, monitoring compliance metrics, and collaborating with departments to address gaps effectively.

• Conducted in-depth research on legislative updates to proactively update compliance strategies and frameworks for internal and external audits.

• Achieved 100% audit scores in compliance with NCQA and regulatory standards by diligently managing audit preparations, executing corrective actions, and updating the database.

• Coordinated with cross-functional teams to optimize audit workflow and reduce processing times.

• Delivered data-driven insights to senior management for informed decision-making by monitoring compliance metrics and generating detailed reports.

Alvis Locks

Pearland, TX 832-***-**** **********@*********.*** Cardiovascular Care Physicians Houston, TX (Remote) Credentialing Specialist – Data Integrity Aug 2019 – Oct 2022

• Administered physician data within the CACTUS database to check accuracy and compliance with credentialing standards.

• Minimized document discrepancies and upheld credentialing records in collaboration with medical staff officers.

• Maintained a 99% accuracy rate for a large physician group by managing credentialing and re-credentialing processes, verifying insurance information, and conducting regular audits to improve data integrity.

• Performed primary source verifications, including license validation, board certifications, and sanction activity reviews, ascertaining compliance with healthcare regulations and maintaining accurate provider credentials.

• Monitored and assigned incoming paper credentialing applications while ensuring compliance with accreditation standards. Neighbors Physician Group Houston, TX

Credentialing Coordinator Sep 2014 – July 2019

• Supervised the credentialing process for healthcare professionals to guarantee compliance with industry regulations and organizational policies.

• Documented a reliable and accurate provider database by carrying out background checks and primary source verifications.

• Handled emergency medicine physicians' files while checking provider eligibility for contracts and reimbursement, identifying possible delays, and confirming timely renewals.

• Enabled provider readiness for immediate clinical responsibilities and enhanced departmental efficiency by optimizing temporary privilege processes.

• Outreached providers and guaranteed credentialing application integrity by gathering the required documentation and resolving discrepancies.

• Facilitated the re-credentialing process by verifying physician qualifications and timely submission of necessary documentation in coordination with medical staff, keeping compliance with accreditation standards and healthcare regulations.

• Devised and updated tracking systems to track credentialing timelines and follow-up activities, supporting operational workflows. Harris Health, Community Health Choice Houston, TX Provider Contract Coordinator Aug 2012 – Aug 2014

• Navigated end-to-end contract administration, including preparation, mailing, and tracking responses while serving as the primary liaison with providers.

• Integrated physician data into QNXT/CACTUS databases to strengthen data accuracy and elevate retrieval efficiency.

• Executed primary source verifications to validate provider credentials and compliance with contract terms.

• Initiated outreach efforts to maintain proactive communication with providers regarding contract status and requirements. Professional Career Break (May 2010 – Aug 2012)

• Took a professional career break to pursue an Associate's degree in Paralegal Technology, honing expertise in legal research, document preparation, and case management for future career growth. Cigna Healthcare Houston, TX

Provider Relations Associate Apr 2000 – May 2010

• Handled credentialing process for a large network of providers while optimizing contract administration operations, refining onboarding workflows, and reducing document processing time in compliance with industry and organizational standards.

• Kept accurate and up-to-date provider information in company databases to uphold data integrity.

• Conducted primary source verifications to check data accuracy and strengthen relationships with trustworthy providers. EDUCATION

Bachelor of Science (BS) in Business University of Phoenix Oct 2020 Associate of Science (AS) in Paralegal Technology Houston Community College May 2012

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