Elyse Markwitz
Director of Medical Credentialing and Quality Assurance at University of Maryland School of Dentistry- Claim this Profile
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Bio
Credentials
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Life and Health Insurance License
State of Maryland
Experience
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University of Maryland School of Dentistry
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United States
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Higher Education
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1 - 100 Employee
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Director of Medical Credentialing and Quality Assurance
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2015 - Present
- Responsible for handling high level patient complaints in a timely manner. Involves communicating with the patients, attorneys, MSBDE, Attorney General’s office, State Boards, Dental School Faculty, UMB Legal, and various representatives.- Monitors and reports monthly complaint trends and summary reports to the Quality Assurance Committee- Represents the Assistant Dean on internal committees and chairs meetings as necessary.- Reviews, drafts, and monitors Dental School Contracts, Grants, and Affiliation Agreements and their budgets.- Schedules students for rotation in the clinics for Contracts and assures their CPR, HIPAA tests, Infection Control tests are taken.- Assists Faculty in writing policy and procedures and monitors same for State and Federal compliance.- Developed a database to monitor approximately 1,000 Faculty and all clinical personnel’s License and CPRs and other required information for Liability Insurance Carrier and Accreditation compliance.- Designed and wrote Quality Assurance Manual. Update the manual when appropriate.- Developed Quality Assurance reports to ensure compliance.- Perform quarterly patient satisfaction surveys, tally results and report results and trends with suggested corrective action plans or quality improvements to the Quality Assurance Committee.- Perform monthly chart audits and report results to the Quality Assurance Committee.- Developed and perform quarterly reports for Dental School to the Liability Insurance Carrier.- Create, perform and submit annual reports to the Liability Insurance Carrier. Reduced the School’s premium by over 60% due to accurate reporting of faculty, patient visits and clinical personnel.- Member of the Quality Assurance and Biosafety Committees for Dental School and takes minutes.- Performs/handles the Credentialing of 300 providers for participation with the various Insurance Companies. Show less
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Executive Assistant to the Assistant Dean of Clinical Affairs
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2007 - 2015
- Responsible for handling high level patient complaints in a timely manner. Involves communicating with the patients, attorneys, MSBDE, Attorney General’s office, Dental School Faculty, UMB Legal, and various representatives.- Monitors and reports monthly complaint trends and summary reports to the Quality Assurance Committee- Represents the Assistant Dean on internal committees and chairs meetings as necessary.- Reviews, drafts, and monitors Dental School Contracts, Grants, and Affiliation Agreements and their budgets.- Schedules students for rotation in the clinics for Contracts and assures their CPR, HIPAA tests, Infection Control tests are taken.- Assists Faculty in writing policy and procedures and monitors same for State and Federal compliance.- Developed a database to monitor approximately 1,000 Faculty and all clinical personnel’s License and CPRs and other required information for Liability Insurance Carrier and Accreditation compliance.- Designed and wrote Quality Assurance Manual. Update the manual when appropriate.- Developed Quality Assurance reports to ensure compliance.- Perform quarterly patient satisfaction surveys, tally results and report results and trends with suggested corrective action plans or quality improvements to the Quality Assurance Committee.- Perform monthly chart audits and report results to the Quality Assurance Committee.- Developed and perform quarterly reports for Dental School to the Liability Insurance Carrier.- Create, perform and submit annual reports to the Liability Insurance Carrier. Reduced the School’s premium by over 60% due to accurate reporting of faculty, patient visits and clinical personnel.- Member of the Quality Assurance and Biosafety Committees for Dental School and takes minutes.- Performs/handles the Credentialing of 300 providers for participation with the various Insurance Companies. Show less
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Johns Hopkins HealthCare
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United States
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Hospitals and Health Care
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300 - 400 Employee
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Director, Dental Services
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2001 - 2007
- Provide overall direction, management and coordination of the Johns Hopkins HealthCare: 1) Medicaid Dental Program for Priority Partners Managed Care Organization reported directly to the CEO (2001-2005) 2) EHP and USFHP Dental Program –reporting to the Sr. Director of Quality Improvement (2005- 2007).- Responsible for public leadership while promoting and initiating pilot projects to address the oral health needs in the HealthChoice Program through continuous outreach to various public health officials and state regulators.- Develop and implement pilot programs in collaboration with local health departments, community health centers, state officials and area dentists. Appointed and served on the DHMH Oral Health Advisory Committee.- Formulate initiatives to achieve regulatory requirements for children’s dental utilization for the Medicaid program.- Meet with various legislators to keep them informed of educational information with regard to the activities and successes of Priority Partners Managed Care Organization’s oral health initiatives in order to create policy and regulatory changes.- Work closely with and oversee dental vendor to meet utilization requirements as mandated by Senate Bill 590.- Responsible for monitoring of dental claims/encounters, utilization and overall dental programs and deals with patient complaints. Write policies and procedures. Show less
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Network Manager
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1998 - 2001
- Recruited, contracted and negotiated fees with facilities and healthcare providers for an assigned medical territory.- Educated and trained providers and their staff by clearly and effectively presenting all four insurance products/programs with a total combined membership of 172,000 members.- Performed site audits and reported results.- Utilized interpersonal skills to build trust and further enhance and advance relationships with the providers and their staff. Applied analytical and problem solving skills, in order to resolve provider inquiries.- Acted as a liaison between the provider and various departments within JHHC. Promoted to Dental Director-2001. Show less
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Dental Network Coordinator/ Manager
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1996 - 2001
- Developed, created, marketed and managed a startup Dental PPO Network and benefit plan design for the Maryland, DC, Northern Virginia, Southern Pennsylvania area for Johns Hopkins HealthCare. Recruited over 450 general dentists and specialists for 20,000 members.- Researched, analyzed, designed and developed the dental fee schedules, dental benefits and plan designs, provider contractual agreements, quality assurance criteria and dental selection criteria. Performed fee schedule analysis and savings model.- Created a dentist’s database in Microsoft Access to house provider information.- Designed, developed and clearly communicated a policies and procedures manual for participating providers.- Coordinated and managed the Medicaid Dental Program for Priority Partners (PP) MCO.- Developed, created and communicated our annual MCO’s dental plan to the Department of Mental Health and Hygiene. Reported these results to the Department of Health and Mental Hygiene throughout the year. Extensive written and verbal communication and interaction with top management, State officials, clients, dentists and vendors.- Interacted daily with oral health state officials.- Educated and trained dental providers and their staff by clearly and effectively presenting the dental program.- Initiated, created and participated in the St. Mary’s County Dental Pilot program. This included utilizing: extensive relationship, collaboration, trust building, negotiating, and effective listening and follow through skills.- Participated on the dental credentialing review committee. Promoted to Dental Network Manager-1997. Accepted additional medical territory responsibilities as Network Manager-1998. Show less
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Education
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University of Maryland University College
Bachelor's degree, Business Management
Community
