ST PAUL, MN 2018 to Present
Fairview is an award-winning nonprofit health care system that provides exceptional, coordinated health
care - from preventing illness and injury to caring for the most complex medical conditions.
• Reviews and verifies credentialing information for healthcare providers so Fairview, HealthEast, and contracted entities can evaluate practitioners' ability to provide quality patient care and minimize risk.
- Credentialing Coordinator at FAIRVIEW SYSTEM CREDENTIALING OFFICE
- Service Line Scheduler/Time Card Processor/Lead Trainer at HEALTHEAST PRIMARY CARE CLINICS
- Clinic Coordinator/Administrative Assistant at PEOPLE INCORPORATED STARK MENTAL HEALTH CLINIC
1 year at this Job
- Bachelors in Science Degree Track
Credentialing Coordinator. Previously worked in the billing department before being promoted to the Credentialing department.
- Credentialing Coordinator at Kopp Medical Billing Agency
3 years, 5 months at this Job
- Some college
• Credentialing coordinator in Provider Relations and Contracting
• Process recredentialing and credentialing applications by verifying education, board certification, license, etc following NCQA and Joint Commission Standards
• Maintain provider directory
• Compose letters, meeting minutes and agendas using Microsoft Word
• Accurately enter new contracts into Cactus software
• Using Excel, analyzed delegate rosters by filtering, sorting and grouping provider and practice information
• Renew state license and DEAs and maintaining the information in Microsoft Access
• Compose emails to various contacts and providers via Microsoft Outlook
- CREDENTIALING COORDINATOR at MARSHFIELD CLINIC HEALTH SYSTEM-SECURITY HEALTH PLAN
- CERTIFIED MEDICAL ASSISTANT at MARSHFIELD CLINIC HEALTH SYSTEM-SECURITY HEALTH PLAN
2 years, 10 months at this Job
- DIPLOMA - Medical Assistant Program
Credentialing Coordinator for surrounding critical access hospitals and healthcare facilities in Altru Health Systems Extended Network. Coordinator on committee for new facilities in this healthcare system. Completed verification and contacts for providers needing credentialing Input new providers in EPIC, the electronic medical record they currently use. Daily communication with other facilities on their needs and what we need from them.
- Credentialing Coordinator at Altru Health System
- Optometric Assistant at Sanford Health, Fosston
- at Thrivent Financial
- Administrative Intern at Woodside Village
6 months at this Job
- MBA - Healthcare Management
- Associates of Applied Sciences - (AAS) Geospatial Intelligence Analysis
- Bachelor of Science - (BS) Healthcare Management
Multi-line phones, checking in patients, receiving patient payments, scanning and emailing for billing, deposit logs, filing, light scheduling of cases as well as entering insurance verification and notes, receiving and sorting daily mail and distribution, patient collections. Materials Management (Back-up) Assisting in ordering and receiving office and medical supplies, handling packing slips and unpacking medical and office supplies. Patient Champion Responsible for ideas in raising patient satisfaction scores for the facility, works with other employees to implement ideas to raise facility scores, checking reports and keeping employees aware of those scores gathered through Press Ganey. Credentialing Coordinator Responsible for putting together new credentialing packets and sending out to prospective physicians, receiving completed packets, verifying licenses, DEA, data banks and AMAs, updating system with physician's information, continuing the re-credentialing process when a physician's term is near, verifying hospital affiliations, sending and receiving physician's references and corresponding with other credentialing coordinators for pertinent information. Accounts Payable Receiving invoices and entering into system, perform check runs, runs end of the month reports to correct any errors or rejections before close, correspond with various vendors via phone and email regarding accounts, and working statements, working end of the month accrual report.
- Credentialing Coordinator at Beaumont Surgical Affiliates
- backup manager at Lumberton Independent School District
- Data Conversion Operator at United States Postal Service
- Warranty Clerk/ Head Service Cashier/ Switchboard Operator at Chevyland/ Autoplex
2 years at this Job
- - Medical Assistant Program
- High School Diploma
checklist for all physicians and mid-level practitioners which includes verification all state license(s), CSR, DEA, board certification and NPI number; request certificate of insurance, run background check; set-up provider as a vendor; submit provider's direct deposit to Corporate Treasury
• Facilitate the process of obtaining new licenses for providers for assignments as needed. Ensure all required documentation is complete and submitted in a timely manner.
• Complete facility and state specific credentialing applications per provider (ranging from 5 pages to 60 pages per application)
• Forward credentialing and/or licensing application(s) to provider with detailed instructions for completion
• Ensure that all the provider's supporting documentation is on file to support required credentialing application(s)
• Track credentialing and/or licensure applications and maintain constant communication with provider to ensure application and all supporting documents are returned in a timely manner
• Provide facilities with all required credentialing paperwork; maintain constant contact with facility credentialing coordinator to assist until provider's file is completed and provider is cleared to start work
• Ensure all internal relevant parties are kept apprised of physician status throughout credentialing and/or licensure process
- Credentialing Coordinator at ProCare One Nurses LLC
- Product Specialist at Nudestix Cosmetics
- Product Specialist at Merrylaz Aesthtics USA
- Sales Specialist at L'Oréal
5 months at this Job
- Bachelor of Science - Human Resources
- HS Diploma
* Credentialing Coordinator to gastroenterology group consisting of 70 + providers, 8 clinic offices and 5 ambulatory surgical centers. * Created and implemented new credentialing processes and was commended for improvements made to department by The Joint Ventures of The Charlotte Mecklenburg Hospital Authority Board of Directors. * Conduct provider on-boarding by obtaining appropriate licenses, finalizing insurance contracting and completing hospital privileging at local hospital systems. * Responsible for maintaining all aspects of credentialing in accordance with state and federal law. * Assist billing manager with month end reporting and performance analytics.
- Credentialing Coordinator at Carolina Digestive Health Associates, PA
- Practice Manager at Carolina Comprehensive Health Network
- Medical Biller/Front Desk Associate at Carolina Family Medicine & Urgent Care
3 years, 11 months at this Job
- A.A.S - Accounting
- High School Diploma
Duties as Credentialing Coordinator: Fill Out Applications for Centura Provider Credentialing Service (PCS) and Insurance Companies to get New Doctors/Physician Assistants Credentialed with Panorama; Follow Up Weekly to Monthly on Applications to Make Sure they’re being Processed; Gather Information from Provider to Include with Application; Re-Credential all Doctors/Physician Assistants with Centura PCS every Two Years by Re-Submitting Application and Personal Information; Re-Credential Doctors/Physician Assistants with Various Insurance Carriers every Two to Three Years by Re-Submitting Application and Personal Information; Renew Memberships with Various Organizations for Doctors/Physician Assistants Yearly; Obtain Signatures from Doctors on Various Documents throughout the Week; Gather Documentation on Tuberculosis and Flu Vaccinations for Doctors/ Physician Assistants and Providing the Hospitals with that Information, so the Provider can Continue Working at the Facilities; Renew Medical Licenses every Two Years and DEA Licenses every Three Years; Keep Track of all User Names and Passwords for Providers for Various Websites, Such as NPPES/PECOS, CAQH, Medicaid, ABOS, and Updating these Sites with Malpractice Insurance, License Expiration Dates, DEA Expiration Dates, Address Changes, Etc. each Year; Provide Updated Insurance Information and Doctor/Physician Assistant Rosters to Various Departments within Panorama; Keep Track of Credit Card Expenditures and Submit Supporting Documentation to Accounting; Assist Doctors with Submitting Documentation to Renew their Boards. Duties as Data Support Analyst: Check In Scheduled Surgeries in Nextgen; Verify Insurance, Date of Service, and Place of Service for Scheduled Surgeries; Pull Reported Traumas by Doctors and Physician Assistants from the Trauma Box and Find Patient in Epic or Meditech and Transfer Pertinent Information to a Spreadsheet for the Trauma Coders to Work From; Verify, Research and Update Insurance Information on Trauma Patients by Communicating with Accounts Receivable Department; Verify Name and Address of Patient, and Correct if Necessary; Scanning of Trauma Operative, Consult, Procedure, and History Notes into Nextgen; Back-up Scanning of Operative Notes on Scheduled Surgeries for Record Management. Complete Missing Codes and Dollar Amounts Billed for Surgical Assist Billing. Pull Data from Reports in Nextgen and Compile into an Excel Spreadsheet to be sent to Management and Coders.
- Credentialing Coordinator at Panorama Orthopedic & Spine Center
- Duties as Administrative Assistant to Leasing at Denver Mart
- Duties as Office Manager at 5280 Gymnastics
- Duties as Office Manager at Colorado Horse Council/Colorado Horse Development Authority
3 years, 5 months at this Job
- - Psychology
Started as a temp in Accounts Payable helping with vouching over 200+ invoices into Great Plains. During my temping contract I was moved to Payroll and helping with time sheets and preparing checks for over 300+ employees. Became permanent in March as an Accounting Assistant helping with Account Receivables and Cash Disbursements. I reconcile the bank accounts using Great Plains, prepare monthly reports for Capitation members and prepare invoices. Transferred departments in Aug. 2016 to the Business Office and started a new role as a Business Service Coordinator, I am working on patient accounts using IDX and refunding any accounts with a credit balance to either patients that overpaid or insurances that overpaid. Transferred to a new department Aug. 2017, working as a Credentialing Coordinator. Focusing on initial credentials and re-credentials, monthly background checks on physicians, setting up hospital privileges and adding physicians to health plans.
- Credentialing Coordinator at Verity Medical Foundation
- Retail Sales Associate at CENTERPLATE AT LEVI'S STADIUM
- APPAREL GRAVEYARD LEAD at AEROTEK (ZAZZLE)
- ASSISTANT STORE MANAGER at YESSTYLE FASHION
4 years, 2 months at this Job
- - HiSet equivalent certificate
- - Criminal Justice
A $75 million subsidiary of AmeriHealth managed care organization that serves more than 6 million members nationwide.
Credentialing Coordinator 08/2011-Present
• Verifies the credentials of medical providers, facilities/ancillaries and ensures that they are current
• Review medical degree, research and primary source verifies education, board certification, work history and a thorough background check
• Monitor the initial and re-credentialing process for all medical staff, Allied Health Professional staff, Other Health Professional staff, and delegated providers, ensuring compliance with Joint Commission, NCQA, CMS, federal and state, as well as Medical Staff Bylaws, Rules and Regulations, policies and procedures, and delegated contracts.
• Assist with managed care delegated credentialing audits; conducts internal file audits.
• Utilizes the Cactus credentialing database, performs queries, using National Practitioner Database reports in accordance with Health Care Quality Improvement Act.
- Credentialing Coordinator at AmeriHealth Caritas
- Customer Service Representative at AmeriHealth Caritas
- Emergency Room Technician at MEDICAL UNIVERSITY OF SOUTH CAROLINA
7 years, 5 months at this Job
- Bachelors of Science - Human Services