VP, Credentialing and Payer Relations

• Mar 2022 - Present

Sr. Director, Credentialing and Payor Relations

• Dec 2020 - Mar 2022

Director, Credentialing

• Dec 2017 - Dec 2020

National Credentialing Manager

• Nov 2016 - Nov 2017

Manager, Credentialing and Provider Services with Memorial Health Partners

• 2014 - Nov 2016

•Accountable for management, oversight and integrity of the credentialing functions for over 2,000 providers in the Memorial Health Partners (MHP) network. •Manages the delegated credentialing activities and reporting for six commercial payers and three Care Management Organizations (CMO), for 215 physicians and mid-level providers employed by the Memorial Health System. •Oversees relationship and works with the Credentials Verification Organization to ensure databases and policies are current and accurate. Audits the CVO activities on an annual basis and audits the network for data accuracy. •Schedules, coordinates and manages bi-monthly MHP Credentialing Committee meetings. Assure appropriate credentialing standards and MHP policies are met. Communicate and discuss non-compliance of credentialing and other MHP standards and policies with the MHP Medical Director and committee physicians. •Schedules and conducts on-site office facility reviews. •Facilitates the resolution of all provider service and MHP network related issues while building strong relationships with physicians, MHP Network Members, Third Party Administrators (TPA), Memorial Managed CareTeam, administrative partners and Managed Care Payers. •Contributes to the development of strategic initiatives for the MHP network and other MHP value-added services. •Plans and organizes an annual MHP Network Provider meeting. Show less

Director, Revenue Cycle Management

• 2012 - 2014

•Served as the primary day to day point of contact for Client Executives and other key personnel for an assigned group of hospital facilities and developed strong relationships with influencers and decision makers. •Excelled in Relationship Management with six major clients ranging from a 35-bed hospital facility to more than a 300-bed hospital facility. •Responsible for analysis and preparation of monthly reporting of service levels. •Facilitated and maintained client relationships by successfully identifying client needs and managing expectations. •Recommended and presented service solutions to clients, collaborating with internal departments to create proposals and pricing. •Successfully facilitated issue resolution through mediation ensuring continued customer satisfaction. •Responsible for direct collaboration with senior executives to effectively communicate performance analysis, strategic planning, and implementation of individualized objectives. Show less

Sr. Consultant

• 2012 - 2012

• Provided analytical and support concepts to Centers for Medicare & Medicaid Services (CMS) for the Provider Enrollment Chain and Ownership System (PECOS). •Developed and submitted plans to CMS for requested or required enhancements and changes to PECOS. •Defined and supported development of requirements for implementation of enhancements to PECOS. •Supported strategic planning and design for achieving new concepts for PECOS. • Provided analytical and support concepts to Centers for Medicare & Medicaid Services (CMS) for the Provider Enrollment Chain and Ownership System (PECOS). •Developed and submitted plans to CMS for requested or required enhancements and changes to PECOS. •Defined and supported development of requirements for implementation of enhancements to PECOS. •Supported strategic planning and design for achieving new concepts for PECOS.

Medicare Part B Provider Enrollment Manager

• 2010 - 2012

•Supervised team of 21 analysts responsible for enrolling physicians into Medicare Part B program.•Handled staffing and addressed human resources issues, while monitoring production to ensure achievement of goals.•Developed reports for CMS on timeliness of various kinds of provider applications.•Improved staff communication, participating in implementation of cross-team meetings to facilitate dissemination of information.•Streamlined processes to increase analysts’ productivity, eliminating redundant and less beneficial processes.•Analyzed production data to establish standards for productivity; reviewed staff quality and reported on accuracy. •Initiated processes involved with launching new provider enrollment unit in Dallas office, spearheading planning efforts. Show less

Section 1011 Program Management Director

• 2005 - 2010

•Played key role in initial operational startup of Section 1011 program including staffing, establishing guidelines according to Section 1011 legislation, developing statement of work requirements and policies, and implementing customized provider enrollment and claims systems. •Directed staff of two managers and one administrative assistant, with indirect oversight of 47 employees and budgetary responsibility for $32 million contract.•Managed claims, customer service, dispute resolution, provider enrollment, provider relations and medical review activities, including designing quality program and accuracy requirements.•Reviewed and interpreted CMS directives and maintained ongoing working relationships with CMS.•Responded to CMS representatives’ questions relative to reports, complaints from Congress or rates of payment.•Oversaw conference calls for providers, billers and others involved with Section 1011 to provide training and open lines for questions. •Spearheaded development of Web content, communications to health care providers, and medical review guidelines.•Drove Web-based training for physicians and providers associated with hospitals and ambulance companies, as well as their billing teams on enrollment, claims payments, filing and overpayment procedures and eligibility. •Implemented ISO 9001:2000 standard requirements for program management division and achieved ISO 9001:2000 division registration.•Planned and led provider outreach sessions in various cities to introduce program and answer questions.•Functioned as program manager for National Disaster Medical System (NDMS) portion of Section 1011; established claims processing guidelines and reimbursement procedures for acute inpatient care provided to NDMS placed patients following natural disasters and associated evacuations. Developed website and training materials. •Wrote portions of responses to proposal requests from CMS; developed resources estimates and needs justifications. Show less

OCR and Medicare Part B Claims Manager

• 2001 - 2005

•Managed three supervisors with indirect oversight of 56 employees including scan operations staff, data entry clerks, workflow clerks, and testing administrator; prior to Part B claims reorganization, managed four supervisors and 76 employees.•Oversaw scanning and OCR verification/data entry of Medicare Part B claims for five states; tracked OCR claim receipts, production, timeliness, and performance. •Ensured CMS-required management controls and security restrictions were in place and appropriately tested; verified any changes needed to OCR system were made and tested within established time period.•Implemented scanning process that could accommodate multi-page claims, and implemented new OCR system which incorporated new scanning equipment and data entry software.•Forecasted workloads in order to plan resources needed to maintain and exceed CMS claims processing timeliness requirements.•Achieved unit registration according to ISO 9001:2000 guidelines. Show less

Client Services Manager

• 2000 - 2001

•Liaised with clients as manager for eight accounts; built and maintained relationships with new and existing customers, ensured compliance with contracts, recognized changing needs, and proposed additional services to add value to customers’ business. •Reported performance results against service levels, projects, and other deliverables in monthly client service reports. •Liaised with clients as manager for eight accounts; built and maintained relationships with new and existing customers, ensured compliance with contracts, recognized changing needs, and proposed additional services to add value to customers’ business. •Reported performance results against service levels, projects, and other deliverables in monthly client service reports.

Dealer Services Manager - Timeslips Software

• Jul 1999 - Jun 2000

•Interfaced with resellers and consultants of Timeslips software across 12 U.S. states and Canada. •Served as sales representative for corporate, educational institutions, nonprofit organizations, and government accounts. •Interfaced with resellers and consultants of Timeslips software across 12 U.S. states and Canada. •Served as sales representative for corporate, educational institutions, nonprofit organizations, and government accounts.

Customer Service Manager

• 1997 - 1999

•Supervised 14 customer service representatives and support specialists; created and implemented customer service quality review call monitoring program and training materials. •Managed Voice Response Unit and phone statistics and gave demonstrations to clients and potential clients. •Supervised 14 customer service representatives and support specialists; created and implemented customer service quality review call monitoring program and training materials. •Managed Voice Response Unit and phone statistics and gave demonstrations to clients and potential clients.

Manager, Customer Call Center; Claim Service Rep, Technical Assistant, Claims and Customer Service

• 1991 - 1997

Manager, Customer Call Center; Claim Service Representative; Claim Examiner, Technical Assistant, Customer Service Manager, Customer Call Center; Claim Service Representative; Claim Examiner, Technical Assistant, Customer Service