Experience

Magellan Behavioral Health

• Retail Art Supplies
• 300 - 400 Employee

• Senior Credentialing Specialist

  • Mar 2019 - Present

  • Maintains current knowledge of credentialing laws and regulations of Magellan Health and other state and federal regulations. • Serves as point-of-contact for internal credentialing audits. • Oversees developments and distribution of provider network reports. • Effectively works with internal departments and clinical support to identify best practices and opportunities to improve quality performance. • Works with Network Management team, study managers and regulatory personnel to achieve goals for quality assurance and compliance. • Manages the credentialing process and set infrastructure to collect data and communicate new provider additions, terminations, and demographic changes within payor credentialing department and the IPM markets. • Works to minimize unnecessary write off’s due to delays in the enrollment process or other related factors. Show less



Traci Lynn Jewelry

• Ft.Lauderdale, FL

• Independent Business Owner

  • Dec 2009 - Feb 2020

  I reflected back through the thousands of hours I have spent over the 9 years Coaching and Inspiring women to achieve their goals. I thought of the single moms who just wanted more time with their kids, the college students with student loans leering above their heads, the empty-nesters looking for a new passion, the Corporate burnouts who wanted something more fulfilling, the newlyweds wanting to buy a new home… I reflected back through the thousands of hours I have spent over the 9 years Coaching and Inspiring women to achieve their goals. I thought of the single moms who just wanted more time with their kids, the college students with student loans leering above their heads, the empty-nesters looking for a new passion, the Corporate burnouts who wanted something more fulfilling, the newlyweds wanting to buy a new home…



EvergreenHealth

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Credentialing Manager

  • Jun 2017 - Nov 2018

  • Provided leadership, operational oversight, and management to the Credentialing team. • Tracked departmental output and implemented corrective actions. • Identified and drove creative solutions for problems. • Oversaw all aspects of the credentialing/recredentialing process to ensure rapid turnaround and compliance with NCQA standards and other state and federal regulations. • Served as point-of contact for external delegated credentialing audits, ensuring that the credentialing/ re-credentialing activities were compliant with NCQA standards and other state and federal regulations. • Performed internal credentialing audits. • Oversaw the credentialing / re-credentialing activities for all network contracted facilities including, but not limited to hospitals and ambulatory surgical centers. • Performed delegated oversight of Credentialing Verification Organization (CVO). • Coordinated and provided staff support for the Provider Advisory & Credentialing Committee (PACC). Show less



Avēsis

• United States
• Insurance
• 300 - 400 Employee

• Senior Credentialing Coordinator

  • Jan 2016 - Jan 2017

  • Oversaw a team of 8 professionals, ensuring that team members responsibilities were defined and understood. • Created credential-related reports for division chiefs, division managers and search committees. • Responsible for the quality improvement of systematic and continued actions that lead to measurable improvement with Avesis of the target provider group. • Coordinated the management the credentialing database and associated modules, ensuring accuracy of the data and reporting. • Monitored and reported the turnaround time and processing of credentialing applications. • Participated in the development and review of CVO operating policies and procedures. • Coordinated credentialing audits in compliance with Health care delegated credentialing contracts. Show less



Saint Agnes Hospital

• 900 Caton Avenue

• Credentialing Coordinator

  • May 2013 - Dec 2016

  • Oversaw a team of 8 professionals, ensuring that team members responsibilities were defined and understood. • Created credential-related reports for division chiefs, division managers and search committees. • Responsible for the quality improvement of systematic and continued actions that lead to measurable improvement with Avesis of the target provider group. • Coordinated the management the credentialing database and associated modules, ensuring accuracy of the data and reporting. • Monitored and reported the turnaround time and processing of credentialing applications. • Participated in the development and review of CVO operating policies and procedures. • Coordinated credentialing audits in compliance with Health care delegated credentialing contracts. Show less



Magellan Health

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Credentialing Coordinator

  • Oct 2012 - Mar 2013

  • Oversaw a team of 8 professionals, ensuring that team members responsibilities were defined and understood. • Created credential-related reports for division chiefs, division managers and search committees. • Responsible for the quality improvement of systematic and continued actions that lead to measurable improvement with Avesis of the target provider group. • Coordinated the management the credentialing database and associated modules, ensuring accuracy of the data and reporting. • Monitored and reported the turnaround time and processing of credentialing applications. • Participated in the development and review of CVO operating policies and procedures. • Coordinated credentialing audits in compliance with Health care delegated credentialing contracts. Show less



Kaiser Permanente

• 6111 Executive Blvd

• Credentialing Coordinator

  • Oct 2005 - Mar 2012

  • Conducted audits of the Health Plan & MAPMG, Network Providers and Kaiser Permanente clients. • Conducted NCQA audits on all credentialing and recredentialing files prior to submitting to the Credentialing Committee. • Initiated and followed through on all aspect of the privileging and re-privileging of Mid-Atlantic Permanente Medical Group physicians with Ambulatory Surgery Center (ASC) privileges. • Partnered with necessary staff to ensure an integrated, timely, and consistent product. • Collaborated with Human Resources and MAPMG recruiters to monitor the recruitment status of candidates ensuring timely credentialing prior to employment. • Completed the credentialing and recredentialing of MAPMG & Health Plan. • Prepared monthly reports regarding the progress of credentialing and recredentialing of appointees. • Worked with other Kaiser Permanente staff to identify areas of performance that required attention. • Assisted in the development of corrective action plans. • Responsible for requests for Locum Tenens & temporary privileges utilizing guideline procedures established by Kaiser Permanente. Show less



APS Healthcare, a subsidiary of Universal American

• United States
• Hospitals and Health Care
• 300 - 400 Employee

• Credentialing Auditor

  • Jan 2002 - Oct 2005

  Duties: Supervise, lead and trained 9 Credentialing staff members. Provide training /education to new hires and current staff, regarding current/new NCQA/URAC standard. Liaise with contract Manger to ensure receipt of independent and /or group contracts and fee schedules. Conduct audit of all files prepared by the Credentialing Specialist/Contract Manager for a detailed review by the Credentialing Committee. Ensure files are in compliance with federal, state, company, and client regulations. Collaborate with management to develop and maintain work plans and process improvement initiatives that includes duration estimate and task sequencing processes. In addition, audit legal files to ensure receipt of all legal documentation required for review by Credentialing Committee. Attend monthly Credentialing Committee. Direct Credentialing and Provider relation staff during the file return process to retrieve missing/incomplete documentation. Update provider database and initiate correspondence to ineligible provider in the network. Participate in delegation site visit. Show less