Experience

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  Boston Children's Hospital

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

  • Credentialing / Provider Enrollment Specialist

    • Jul 2017 - Present

    • Responsible for the timely coordination and processing of Enrollment applications with MassHealth/ Medicare/ Third-party Commercial Payers /Out of State Medicare/ payers for the Medical-Dental/ Allied Health Professional.•Monitors the initial, reappointment and expiable process for all medical staff, Allied Health Professional staff, Other Health Professional staff, and delegated providers, ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state), as well as Medical Staff Bylaws, Rules and Regulations, policies and procedures, and delegated contracts.• Acts as liaison to Faculty Practice Foundation and hospital departments, outside agencies, physicians, medical practice groups, third-party payers • Accountable for submitting termination requests to all health plans in a timely manner. • Adhere to strict guidelines as established to assure payor and TJC compliance. Participate in audits conducted by the agencies and payors to measure the BMC/FPF compliance rate. • Conducts thorough background investigation, research and primary source verification of all components of the application file; Include a statement of the duties and privileges of each category of medical staff (e.g., active, courtesy, etc.)• Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.

  • Provider Enrollment Specialist

    • Jul 2017 - Present

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  OFI Job Exchange Inc.

  • Boston, MA

  • CEO, President

    • Oct 1997 - Present
    • Boston, MA

    In founding Job Exchange, I based on my own experience of trying to find the job of my dream. After moving to Boston from Moscow I had been working in the field of temporary work and at the time, temporary work was not my desired career at all. After I went four months without finding any jobs wh...

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  Studio Sunday TV, Employment News

  • VP

    • 2010 - 2016
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  MAMSS Conference

  • Credentialing/Provdier Enrollment Coordinator

    • 2014 - 2015
• 

  Fianit, LLC

  • Moscow, Russia

  • HR Supervisor

    • Sep 1991 - Nov 1996
    • Moscow, Russia

    • Provide employees with guidance in handling difficult or complex problems and in resolving escalated complaints or disputes• Implement company policies, procedures, and service standards in conjunction with management• Discuss job performance problems with employees to identify causes and issue...