Experience

Monitoring Concepts

• United States
• 1 - 100 Employee

• Credentialing Coordinator

  • Aug 2019 - Present

  Credentialing/Credentialing of Intra-Operative Neuromonitoring Technicians and Neurologists Credentialing/Credentialing of Intra-Operative Neuromonitoring Technicians and Neurologists



EMERGICON

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Credentialing Specialist

  • Sep 2018 - Aug 2019

  Completes, monitors and follows-up on provider Medicaid and Medicare Part B Ambulance credentialing and revalidation applications. Maintains copies of any required credentialing documents for all providers. Maintains corporate provider contract files. Sets up and maintains provider information in an online credentialing databases and systems. Tracks license and certification expirations for all providers to ensure timely renewals. Ensures provider addresses are current with health plans, agencies and other entities. Maintains daily communication with Medicare, Medicaid and insurance companies to ensure updates are completed within a timely manner. Complies and maintains current and accurate data for all providers. Ability to work within a deadline-intense environment. Demonstrated problem-solving and customer service skills. Perform Medicare and Medicaid Enrollment/Reenrollment and Credentialing for Ambulance and EMS Services. PECOS/TMHP portal experience. VA/SAM Vendor Enrollment Enroll and credential for all commercial payers. Aetna, Blue Cross Blue Shield of Texas, United Healthcare are among some of the larger carriers. Show less



Trans-Century Resources

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Credentialing Specialist

  • Sep 2014 - Mar 2018

  The Credentialing Specialist's primary responsibility is to perform on a daily basis the credentialing of physicians for client PHOs, including data entry, prime source verifications and filing. This includes preparing for credentialing meetings at the instruction of the responsible consultant and keeping the consultant informed of any information received which may need to be brought to the attention of the Medical Advisory Committee. 1. Open Mail, date stamp and separate according to Network. 2. Compare verifications against application and file information. Inform consultant of any adverse information received about a physician. 3. Update pending lists accordingly. 4. Complete data entry on all applications received. 5. Perform credentialing process according to procedure which includes primary source verifications, reference requests and application review. Make necessary requests for missing information by telephone or by writing to physician office. 6. Set up new clients in credentialing software. 7. Maintain status reports for networks and update files after MAC or Board meeting. 8. Prepare and send credentialing status reports to clients and consultants in charge of PHO development. 9. Prepare and send weekly credentialing status report to Credentialing Director. 10. Prepare and send weekly credentialing status report to each credentialing client. 11. Perform credentialing quality improvement checks on completed credentialing files. 12. Prepare and mail application packets to physicians for the networks. 13. Prepare and mail welcome letters/agreement packets to physicians after they have been credentialed by the network board. Show less



Emergency Service Partners, L.P.

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Credentialing Coordinator

  • Aug 2013 - Nov 2013

  The Credentialing Coordinator is instrumental in facilitating the initial and ongoing credentialing process for providers at contracted facilities and hospitals. Obtains billing numbers for practitioners and notifies providers of licensure and certification due dates. Responsible for ensuring that all ESP providers’ licenses are current and collecting, tracking and retaining documentation. Obtains malpractice insurance and performs background checks.facilitate the initial and ongoing credentialing process for providers at contracted facilities and hospitals. Obtains billing numbers for practitioners and notifies providers of licensure and certification due dates. Responsible for ensuring that all ESP providers’ licenses are current and collecting, tracking and retaining documentation. Obtains malpractice insurance and performs background checks. General Responsibilities Initiates, monitors, tracks and completes the credentialing, facility privileges and reappointment process for new hires, rehires and reappointments Liaises with insurance vendors to obtain and provide all necessary, current malpractice insurance documents for providers and communicate personnel changes. Liaises with billing vendors to obtain provider billing information and communicate personnel changes. Establishes and maintains electronic and physical records for the provider credentialing process. Provides facility Trauma Services Department with data and documentation for trauma surveys. Communicates with ESP providers to complete credentialing and reappointment requirements. Notifies practitioners of upcoming licensure renewal dates and ensures documentation is received and provided to facilities and insurance and billing vendors. Facilitate the processing and distribution of Change of Status and New Provider Forms to communicate status updates with Operations, Accounting, Recruiting, Human Resources and other departments as necessary. Show less



Scott & White Healthcare

• United States
• Non-profit Organization Management

• Credentialing Coordinator

  • Jul 2011 - Aug 2013

  Responsible for the computerized operations of the centralized credentials verification system by managing all components of the medical staff database, including data entry, creating reports, and maintaining software. Serves as team member in coordinating medical staff and allied health professional initial appointments and reappointments. Tracks the flow of credentialing information throughout the Scott & White System and to delegating credentialing entities. *Develops standardized system of database entry/attributes and trains staff on standardized data entry to the system. *Utilizes software functions to convert paper documents to electronic files where possible. *Works with IS on web based links to facilitate on-line privilege queries and directories. *Receives applications and enters data and requested privileges into the credentialing database. Prepares application packets for distribution to applicant. *Assigns applicants to appropriate facility(s) and communicates with appropriate facility representatives. *Scans and emails completed credentials files to appropriate facility(s) in a timely manner. *Maintains records of all changes to practitioner status and demographics and communicates to appropriate departments. *Plans and develops supporting documentation (agendas, minutes, reports for Credentials Committee and others as assigned. *Follows departmental expiring document policy to assure proper notification to practitioners of impending expirations. *Accesses primary verification sources to document renewed licenses and certifications, enters renewals into database and files hard copy in credentials file. *Notifies director of expiring documents. *Prepares scheduled and ad hoc reports for both internal and external customers according to established timelines and distribution lists. Show less

• Patient Service Specialist - Neuropsychology

  • Jun 2010 - Jul 2011

  • Provides clerical support for an assigned department or area and coordinates daily patient activity• Promptly answers and screens phone calls for the area, routing calls as appropriate within established customer service guidelines.• Coordinates with physician the completion of charge documents for effective billing of services.• Promptly obtains and verifies patient insurance information.• Maintains physician schedules in order to maximize resource utilization of senior staff.• Accurately and promptly schedules, reschedules and cancels physician appointments so as to maximize resource utilization of senior staff for optimum efficiency.• Greets patients and ascertains their needs in a professional and courteous manner.• Interprets physicians orders to correctly order ancillary tests in accordance with current CPT criteria, ensuring that an appropriate ICD code has been attached to the order and reflects the clinical history as indicated by the physician. Show less