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Professional Summary
Highly analytical healthcare administrator combining more than 6 years of work in credentialing (Hospital & MCO) with proficiency in standards, procedures, policies, and operations with process improvement capabilities. Adaptable and accustomed to the integration of new database and software systems, and restructuring of work in an increasingly complex regulatory environment. A detail oriented and energetic/professional team player who is capable of working on own initiative along with the ability to produce accurate results under pressure. *Analytical & problem solving skills, detail oriented, communication/interpersonal skills, organization/time management skills *Data management, reporting, analyzation of data quality *Quality/Process improvement competency *Developing extensive reports for review and compliance *Ability to effectively meet challenges and deadlines *Extensive computer knowledge at a high proficiency level: MSOW, ECHO, CACTUS, STAR, CRIMSON, Salesforce, Facets, Evernote, Smartsheet, Sharepoint, CAQH Proview, Microsoft Office-All Application, Adobe Pro
Skill Highlights
Professional Experience
Supervisor / Visiting Nurses Services of NY, CHOICE Health Plans - New York, NY 08/2016 - Current
  • Knowledge of Joint Commission/NCQA credentialing/CMS regulatory standards/credentialing statutes and.
  • regulations for hospitals, MCO, delegated credentialing entities, and CVOs Develop and implement policies and procedures for the credentialing department and ensuring the health plan meets NCQA and state regulatory guidelines/standards and CMS directory requirements Improve efficiency of the credentialing team by implementing procedures and processes that increases productivity by getting providers in network.
  • Create new provider forms to be utilized across the department (i.e.: Provider Update Form, ADA Accessibility Form, Access and Availability form, Provider applications, credentialing checklist and requirements).
  • Supervise and coordinates activities related to credentialing and re-credentialing of network providers, while ensuring adherence to the Health Plan, regulatory, industry and delegation standards.
  • Team lead on credentialing audits (MLTC, Medicare, Select Health) and delegated credentialing audits.
  • Lead multiple projects (Social Adult Day Care Annual Audit, HIV PCP data clean up, provider directory and data clean up.
Senior Manager / New York Network Management, IPA - Brooklyn, NY 11/2015 - Current
  • Develop policies and procedures for the credentialing of independent medical and allied health practitioners for NYNM; ensures that credentialing policies meet NCQA and state regulatory guidelines/standards.
  • Develop and maintain systems for ensuring compliance with laws, rules, regulations and accreditation requirements; maintain oversight of NYNM database.
  • Standardize forms used throughout the System for the credentialing of licensed, independent medical and allied health practitioners.
  • Provide initial and ongoing training of credentialing to all credentialing staff to assure consistent implementation.
  • Audit records at pre- determined intervals to ensure that the process is being followed and credentials are current, with no lapses.
  • Develop and maintain reporting systems to provide timely information to administration regarding compliance status with guidelines, rules/regulations and internal policies and procedures (works through staff so that a systematic process for monitoring and reporting is timely and appropriate).
  • Work with NYNM management to ensure the readiness of the organization for accreditation surveys and other compliance inspections.
Credentialing Supervisor / 03/2013 - 11/2015
Credentialing Coordinator / NYU Lutheran - Brooklyn, NY 07/2012 - 03/2013
  • Supervise the application process for new medical/dental staff applicants and reappointment process; including primary source verification of credentials, evaluation of information collected for adequacy and completion, and the pursuit of additional information.
  • Closely monitor the information collected to assure it meets Joint Commission, DOH, and other regulatory requirements; ensure the quality assurance standards are upheld and conducts continuous audits as a means of oversight.
  • Supervise the credentialing coordinators on all activities to ensure that quality standards are met.
  • Identify steps individual employees can take to promote growth, development, and workplace wellbeing as part of competency assessment, performance planning, and appraisal process.
  • Coordinate maintenance of credential files and update ECHO database as necessary; generate profile and/or reports from Echo, assemble all verified information, and prepare credential files for presentation at the Credentials Committee meetings.
  • Work with the Professional Practice Evaluation Coordinator to assure that all Initial, Focused, and Ongoing Professional Practice Evaluations are processed.
  • In conjunction with director, manages the hospital's additional insured list.
  • Expedite problem solving and provides service support to physicians and other professional contacts.
  • Assist in setting up office systems for credentialing related matters.
Credentials Analyst / NY Presbyterian Hospital - New York, Columbia, NY 12/2010 - 07/2012
  • Process all initial and reappointment applications for Medical/Allied Health Professional Staff appointments and clinical privileges to meet policies and procedures, Medical Staff Bylaws, and JCAHO standard.
  • Process applications for temporary or one-case privileges, according to policy and procedure.
  • Prepare/update files for audits/surveyors and maintain/input electronic data.
  • Collect and maintain files in relation to credentialing, including applications, current licenses, DEA license, malpractice insurance, board certifications, and other pertinent forms.
  • Assemble, prepare, and submit credentialing information and applications to manager, medical director for Credentialing Committee/Medical Board/Board of Trustees review.
Education and Training
State University of New York - Buffalo Amherst, NY 2009 B.A: Social Science-Health & Human Services Social Science-Health & Human Services Cum Laude
Skills
ADA, CMS, database, DOH, forms, insurance, Team lead, director, meetings, Access, office, works, network, policies, Develop policies, problem solving, processes, quality, quality assurance, maintain files, update files, reporting, surveys
This resume is created in 7 minutes.
Professional Summary

Experienced RN and Risk Manager with strong clinical and people skills. Knowledge of the consenting process, reporting requirements for adverse events, standard of care, and hospital work-flow operations.

Licenses

Registered Nurse RN

License Health Risk Manager (LHRM)

Skill Highlights
  • Skilled cardiac care nurse
  • Committed to compliance reporting
  • Personable
  • Process improvement strategies
  • MIDAS reports expert
  • Medical clinical procedures comprehension
  • Team player with positive attitude
  • Relationship building
  • Troubleshooting and problem solving
  • Flexible
  • Maintains strict confidentiality
  • Extensive anatomy/physiology knowledge
  • HIPAA compliance
Professional Experience
06/2009 to Current
Risk Manager Miami Children's Hospital － Miami, FL

Manage MIDAS incident reporting system including continuous process improvement.

Develop and provide Risk Management orientation to new employees.

Investigate and report to DOH all allegations of sexual misconduct.

Support claim management including responding to requests for productions.

Conducted over 35 Root Cause Analysis (RCA) using the 5 Why 7 Way technique. Selected as lead for assuring the success of the RCA process.

Conduct chart reviews to determine potential exposures to the organization and assure standard of care is maintained.

Practice Enterprise Risk Management.

Complete potential compensatory reports for malpractice and general liability insurance carriers.

Spearheaded a multi-disciplinary team focused on issues related to electronic medical records and patient safety.

Assure organizational compliance in the process for obtaining consents by supporting employees in determining appropriate parties to consent for treatment in minors or incapacitated individuals.
05/2008 to 06/2009
Pediatric Emergency Room RN Homestead Hospital － Miami, FL

Provided care to patients presenting to the ER including assessing, administering medications and treatments, monitoring responses to treatment and assuring patients admission/discharge.
01/2006 to 06/2009
Per Diem Staff RN II Miami Children's Hospital － Miami, FL

Served as rotating RN to all areas of the hospital in the capacity of RN as needed.
01/2001 to 06/2009
CPR Instructor Miami Children's Hospital － Miami, FL

Basic Life Support (BLS) & Pediatric Advanced Life Support (PALS) Instructor, American Heart Association.
06/2004 to 01/2006
Cardiac Intensive Care Unit RN II Miami Children's Hospital － Miami, FL

Provided care to critically ill patient population: duties included assessment, data collection, diagnosing, implementing the appropriate plan of care in collaboration with the interdisciplinary team.
07/2003 to 06/2004
Risk Management Specialist Miami Children's Hospital － Miami, FL

Responsibilities included coding of incident reports, investigating incidents, developing timeline reports and supporting the director as needed.
01/2001 to 07/2003
Pediatric Intensive Care Unit RN I Miami Children's Hospital － Miami, FL

Provided care to critically ill patient population: duties included assessment, data collection, diagnosing, implementing the appropriate plan of care in collaboration with the interdisciplinary team.
01/1999 to 01/2001
Nursing Care Assistant Miami Children's Hospital － Miami, FL

Responsibilities included taking vital signs, charting vital signs and basic patient care, phlebotomy, monitoring IV pumps and patient intake and output, assisting physicians with minor procedures, cost control and special equipment set-up.
01/1998 to 01/1999
Nursing Care Technician Baptist Health Systems － Miami, FL

Responsibilities included obtaining and charting vital signs, patient input/output, IV monitoring, glucose monitoring, and basic patient care.
01/1996 to 01/1997
Credentialing Coordinator United Healthcare － Miami, FL

Gathered credentials from potential providers who desired to be accepted by the health care company.
Education and Training
1998
Associate of Science: Nursing Miami Dade College － Miami, FL
1994
Bachelor of Science Degree: Psychology Allied Sciences Howard University － Washington, District of Columbia, United States
This resume is created in 7 minutes.
Summary
Five years of credentialing experience working multiple healthcare environments. Proven ability to work independently and efficiently with superior results. Extremely detail oriented and enjoy working collaboratively with different people and departments to reach a common goal.
Accomplishments
  • Credentialing Experience in maintaining records for multiple providers in various specialties consisting of CV's, all applicable licenses, board certifications, graduate diplomas, professional liability certificates and other applicable documents necessary for thorough credentialing purposes Coordinated provider applications for new and re-enrollments for insurance paneling purposes Ensured accuracy and completeness of all applications prior to submission Expertise in the CAQH databases and NPI registries for the organization and on behalf of each individual provider therein.
  • Responsible for renewing provider's state and federal licenses Experience in AIU attestations through the Medicaid Incentive Payment Program Communication/ Interpersonal Skills Formed strong professional working relationships both within and outside the organization through personal attention, quality service and consistent follow through.
  • Created a "how to" reference guide for the AIU attestation process Provided timely feedback on credentialing status of individual providers through the use of excel spreadsheets Frequently used as a point of contact for general information in the Human Resources Department.
Experience
Community Health Services, Inc FQHC January 2013 to Current Credentialing Specialist
Hartford, Connecticut
L&M Physician Association, Inc January 2010 to January 2012 Credentialing Coordinator
Ledyard, Connecticut
L&M Systems, Inc January 2008 to January 2009 Credentialing Coordinator
Ledyard, Connecticut
Joslin Diabetes & Endocrinology Center January 2007 to January 2009 New London, Connecticut
January 2003 to January 2006 Secretary/ Registrar
Drs. Thompson, Linden, Cooper & Goldberg January 2001 to January 2003 Secretary
Niantic, Connecticut
Education
Western International University 2013 Bachelor of Arts: Behavioral Science Phoenix, Arizona
East Lyme High School 2002 High School Diploma Lyme, Connecticut
This resume is created in 7 minutes.
Summary
Seasoned coordinator seeking a position to enhance my skills and strengths. Highly dependable, flexible, team player and a fast learner. Able to think outside the box. Extensive knowledge and experience of Dental Credentialing and Recredentialing and a great understanding of provider networks.
Work History
Professional Services Services Representative 12/2015 to Current
Delta Dental of NJ – Parsippany, NJ
  • Processing applications for providers joining the companies networks Premier, PPO, Advantage, Patient Direct, PPO Specialist
  • Updating and maintaining providers files on the system (Ice) to participation status once Level 1 committee has approved
  • Assisting providers via phone and e-mail to resolve issues with file fees, applications, changes, terminations
  • File Fee updates from providers log, prep, write up for support staff also update fees for new pars, copying and modifying for errors
  • Assist when needed (special projects) PPO Specialty, directory accuracy, phone calls for inactive non par records
Administrative Support Associate 08/2014 to 12/2015
Delta Dental of NJ – Parsippany, NJ
  • Sending out correspondence to providers via fax, mail or e-mail who joining the network that are missing documents to process applications
  • Fielding phone calls from providers to resolve issues and answer questions regarding network plans
  • Working closely with network coordinators to resolve issues or follow up with applications
  • Opening, sorting, stamping all incoming mail, faxes, e-mailed applications
Customer Service Agent 11/2013 to 08/2014
Delta Dental of New Jersey – Parsippany, NJ
  • Responsible for answering phone calls from providers, subscribers, major accounts and benefit administrators
  • Assisting customers with dental benefit coverage, claims questions, finding a provider in their plan and requesting identification cards
  • Provide assistance with the companies web site including registration, logging on, updating passwords and unlocking accounts
Credentialing Coordinator II 07/2006 to 03/2013
Horizon Blue Cross and Blue Shield of NJ – Newark, NJ
  • Verification of current adequate licencing for the state of NJ, PA, NY checking state websites for status eligibility, verifying up to date information on the  CDS (Control Dangerous Substance), (DEA) Drug Enforcement Administration and Malpractice insurance overage, eligibility and limit amounts are within company requirements       
  • ​Credentialing the network of thousands of providers from start to finish on a monthly basis including running queries, mail merges and mass mailings and phone call follow up
  • Assistant and fill in for my manager in weekly Credentialing Meetings, taking meeting minutes and providing documentation of new providers joining the network, providers being re-crentialed and providers with sanctions against their licence for committee review
  • Assisted manager with meetings and reports for workflows, conversion, network participation
  • Responsible for Credentialing applications for All networks Traditional, PPO, Managed and Medicaid from receipt to network approval and completion
  •  Maintain daily contact with Credentals our Credentialing vendor daily to verify report status on new and existing providers to be Credentialed and Re-Credentialed 
  • Accomplishments in this role as a personal developmental goal include making our weekly Credentialing meeting paperless and setting up a projection presentation
Credentialing Coordinator I 04/2004 to 07/2006
Horizon Blue Cross and Blue Shield of NJ – Newark, NJ
  •  Responsible for Credentialing applications, changes and terminations for providers joining the Traditional, PPO, Managed Care and Medicaid networks
  • Interact daily with Provider Relations Representatives assisting with provider issues to be resolved
  • Provider customer service to providers for network plan information and application follow up
Administrative Clerk 10/2003 to 04/2004
Horizon Blue Cross and Blue Shield of NJ – Newark, NJ
  • Stamp, record and distribute incoming applications, changes, terminations to Credentialing Coordinator
  • Composed and sent letters to providers for joining, terminating and any changes made such as tax identification or change of address to the provider network file
  • Sent recruitment kits to new potential dental providers
  • Prepared hundreds of certified letters and sent mass quantities of mailings to Re-credential providers in the network
  • Assisted with answering phones for CEO of department and dental consultants
Customer Service Account Specialist 05/1997 to 10/2003
Horizon Blue Cross and Blue Shield of NJ – Newark, NJ
  • Provide customer service for network providers, members and group administrators
  • Review, process and pay dental claims to providers
  • Resolve claim issues and inquires
  • Adjustments to claims to pay proper benefits
Education
Associate of Science: June 2001 Union County College - Union, NJ
High School Diploma: June 1988 Kearny High School - Kearny, NJ
This resume is created in 7 minutes.
Summary

Seasoned health care professional with twenty one years of experience. Extensive knowledge of accounting principals, payroll and credentialing. Highly focused and effective problem solver who excels at analyzing, prioritizing and performance driven tasks.

Highlights
  • General and tax accounting 
  • Account reconciliations
  • Analytical reasoning
  • Microsoft applications
  • Compensation/Payroll
  • PeopleSoft knowledge
  • Time Management
  • Spreadsheet development
  • Staff Training
  • Exceptional Interpersonal skills
  • Results-oriented
Accomplishments
  • Operated and Maintained an additional 900 employee staff payroll system for multiple facilities simultaneous due to  unexpected retention.
  • Managed GL entries, reconciliations, fixed assets, cash and analysis for multi subsidiaries while covering vacancies in other departments.
  • Volunteered to train other facilities in tasks that encompass my work experience and job description.
  • Successfully completed a deadline of six weeks in credentialing eighteen staff members for new Nephrology clinic with no prior experience.
  • Chosen to test, analyze and review new payroll system for company wide use in all Healthsouth facilities.
  • Promoted to Senior Accounting Assistant within three months with accountability for several subsidiaries.
Experience
Medical Staff Credentialing Coordinator, 09/1993 to Current HealthSouth Lakeshore Rehab Hospital － Birmingham, Alabama

Analyze and process all medical staff applications.


​Review and verify that all necessary medical staff documentation are in compliance with Joint Commission standards.


​Organize, schedule and record all medical executive,medical staff and PT& T meetings.


​Create data files and spreadsheets on sharePoint and in house communication data bases for management staff.


​Monitor NPDB queries and PSV licensing verification deadlines and expiration windows.​


Maintained confidential information, such as pay rates, bonus targets and pay grades.


Analyze, reconcile and transmit payroll for Lakeshore facility.

​

Train and monitor staff in the policy and use of applications in the payroll system.


Prepare compensation reports for workman's compensation claims. ​


Create marketing intake packet through verification with knowledge of Medicare rules and requirements for State of Alabama. 


Assisted in in other tasks within the facility such as reconciliation of pharmacy, respiratory lab charges.  ​ ​​ ​
Education
Bachelor of Science: Finance Tuskegee University 1986 － Birmingham, Alabama, United States

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Affiliations

Co-Chair of Diversity Committee

Lakeshore Rehabilitation Hospital


Guardian Angel Committee

Lakeshore Rehabilitation Hospital

Recipient of 4th Quarter best angel award 2013


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