Experience

Cook County Health and Hospitals System

• United States
• Medical Practices
• 1 - 100 Employee

• Credentialing Coordinator

  • Oct 2015 - Present

  1.Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility. 2.Conducts thorough background investigation, research and primary source verification of all components of the application file. 3.Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up. 4.Prepares credentials file for completion and presentation to Health System… Show more 1.Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility. 2.Conducts thorough background investigation, research and primary source verification of all components of the application file. 3.Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up. 4.Prepares credentials file for completion and presentation to Health System Entity Medical Staff Committees, ensuring file completion within time periods specified. 5.Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions. 6.Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise. 7.Assists with managed care delegated credentialing audits; conducts internal file audits. 8.Utilizes the Cactus credentialing database, optimizing efficiency, and performs query, report and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act. 9.Monitors the initial, reappointment and expirables 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. 10.Performs miscellaneous job-related duties as assigned. Show less 1.Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility. 2.Conducts thorough background investigation, research and primary source verification of all components of the application file. 3.Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up. 4.Prepares credentials file for completion and presentation to Health System… Show more 1.Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility. 2.Conducts thorough background investigation, research and primary source verification of all components of the application file. 3.Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up. 4.Prepares credentials file for completion and presentation to Health System Entity Medical Staff Committees, ensuring file completion within time periods specified. 5.Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions. 6.Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise. 7.Assists with managed care delegated credentialing audits; conducts internal file audits. 8.Utilizes the Cactus credentialing database, optimizing efficiency, and performs query, report and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act. 9.Monitors the initial, reappointment and expirables 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. 10.Performs miscellaneous job-related duties as assigned. Show less



Access Community Health Network

• United States
• Hospitals and Health Care
• 500 - 600 Employee

• Credentialing Coordinator

  • Feb 2015 - Present

  Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions Responds to inquiries from other healthcare organizations Maintains strict confidentiality of client, company, and personnel information Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility Performs primary and secondary source verification in accordance to company… Show more Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions Responds to inquiries from other healthcare organizations Maintains strict confidentiality of client, company, and personnel information Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility Performs primary and secondary source verification in accordance to company policy Audits files monthly for missing information, requesting information from providers Monitors the initial, reappointment and expirables process for all medical staff, Allied Health Professional staff, Other Health Professional staff, and delegated providers Supports staff with provider recruitment activity Maintains records of applications for follow-ups and verifications. Contributes to overall expansion of the provider network Show less Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions Responds to inquiries from other healthcare organizations Maintains strict confidentiality of client, company, and personnel information Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility Performs primary and secondary source verification in accordance to company… Show more Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions Responds to inquiries from other healthcare organizations Maintains strict confidentiality of client, company, and personnel information Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility Performs primary and secondary source verification in accordance to company policy Audits files monthly for missing information, requesting information from providers Monitors the initial, reappointment and expirables process for all medical staff, Allied Health Professional staff, Other Health Professional staff, and delegated providers Supports staff with provider recruitment activity Maintains records of applications for follow-ups and verifications. Contributes to overall expansion of the provider network Show less



Com

• France
• Advertising Services

• Lead Credentialing Specialist

  • May 2009 - Feb 2015

   Evaluates information on applications to verify completeness and accuracy  Provides credentialing and privileging verifications.  Maintains strict confidentiality of client, company, and personnel information  Reviews licensure and malpractice actions for credentialing criteria guideline review  Performs primary and secondary source verification in accordance to company policy  Prepares files for presentation to the Network Director and Credentialing… Show more  Evaluates information on applications to verify completeness and accuracy  Provides credentialing and privileging verifications.  Maintains strict confidentiality of client, company, and personnel information  Reviews licensure and malpractice actions for credentialing criteria guideline review  Performs primary and secondary source verification in accordance to company policy  Prepares files for presentation to the Network Director and Credentialing Committee  Reviews licensure and malpractice actions for credentialing criteria guideline review  Prepares and distributes minutes to the Credentialing Committee members  Audits files monthly for missing information, requesting information from providers  Supports staff with provider recruitment activity  Maintains records of applications for follow-ups and verifications.  Contributes to overall expansion of the provider network  Corresponds with staff to obtain information or inform them of credentialing status or changes  Coordinates and communicates the activities of the Credentialing Committee  Assists in overseeing the day-to-day operations of the Credentialing Team Show less  Evaluates information on applications to verify completeness and accuracy  Provides credentialing and privileging verifications.  Maintains strict confidentiality of client, company, and personnel information  Reviews licensure and malpractice actions for credentialing criteria guideline review  Performs primary and secondary source verification in accordance to company policy  Prepares files for presentation to the Network Director and Credentialing… Show more  Evaluates information on applications to verify completeness and accuracy  Provides credentialing and privileging verifications.  Maintains strict confidentiality of client, company, and personnel information  Reviews licensure and malpractice actions for credentialing criteria guideline review  Performs primary and secondary source verification in accordance to company policy  Prepares files for presentation to the Network Director and Credentialing Committee  Reviews licensure and malpractice actions for credentialing criteria guideline review  Prepares and distributes minutes to the Credentialing Committee members  Audits files monthly for missing information, requesting information from providers  Supports staff with provider recruitment activity  Maintains records of applications for follow-ups and verifications.  Contributes to overall expansion of the provider network  Corresponds with staff to obtain information or inform them of credentialing status or changes  Coordinates and communicates the activities of the Credentialing Committee  Assists in overseeing the day-to-day operations of the Credentialing Team Show less



Northwestern Medical Faculty Foundation

• United States
• Hospitals and Health Care
• 400 - 500 Employee

• Health Information - Administrative Service Clerk

  • Oct 2000 - Mar 2009

   Scanned medical record documents utilizing EPIC system  Retrieved patient records for medical personnel for appointments  Processed departmental incoming calls  Created and updated medical records as needed  Processed requests for hard copy patient records  Provided effective communication to patient/family, team members, and other health care professionals  Worked as a liaison between the health clinician and billing offices  Performed quality checks… Show more  Scanned medical record documents utilizing EPIC system  Retrieved patient records for medical personnel for appointments  Processed departmental incoming calls  Created and updated medical records as needed  Processed requests for hard copy patient records  Provided effective communication to patient/family, team members, and other health care professionals  Worked as a liaison between the health clinician and billing offices  Performed quality checks, tracks data and generated reports for distribution  Maintained confidentiality of patient information  Assisted in orientation and training of employees as assigned.  Reviewed medical records for completeness, accuracy, and compliance with regulations.  Released information to persons or agencies according to regulations  Processed checks received for copies of patient information Show less  Scanned medical record documents utilizing EPIC system  Retrieved patient records for medical personnel for appointments  Processed departmental incoming calls  Created and updated medical records as needed  Processed requests for hard copy patient records  Provided effective communication to patient/family, team members, and other health care professionals  Worked as a liaison between the health clinician and billing offices  Performed quality checks… Show more  Scanned medical record documents utilizing EPIC system  Retrieved patient records for medical personnel for appointments  Processed departmental incoming calls  Created and updated medical records as needed  Processed requests for hard copy patient records  Provided effective communication to patient/family, team members, and other health care professionals  Worked as a liaison between the health clinician and billing offices  Performed quality checks, tracks data and generated reports for distribution  Maintained confidentiality of patient information  Assisted in orientation and training of employees as assigned.  Reviewed medical records for completeness, accuracy, and compliance with regulations.  Released information to persons or agencies according to regulations  Processed checks received for copies of patient information Show less