Experience

Oloop Technology Solutions

• United States
• IT Services and IT Consulting
• 1 - 100 Employee

• Credentialing and Privileging Specialist

  • Dec 2021 - Present

  Serves as a government contractor providing support for the administration and accountability of the coordinated activities in accordance with policy and direction provided by government lead for the HQ-level Credentialing and Privileging (C&P) Program with the Defense Health Agency.  Assists in the planning, designing, integrating, implementing, modifying, and administering of the HQ-level C&P Program for both privileged and non-privileged providers in a global healthcare entity. Ensures organizational healthcare CQM objectives are achieved as well as successful performance and process improvement outcomes in credentialing and privileging.  Provides coaching, mentoring and education to Markets and MTF.  Performs various tasks such as processing affiliation verification requests, surveillance review audits in CCQAS and providing research support to leadership on various C&P topics.



Neighborhood Health

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

• Credentialing Specialist

  • Feb 2021 - Feb 2022

  Serve as sole internal Credentialing Specialist for thirteen medical, dental and behavioral health FQHC clinics • Coordinate, develop, monitor and maintain the credentialing process for over 85+ medical, dental and behavioral health providers in accordance with internal policies, managed care guidelines, and other regulatory agencies such as HRSA and CMS to ensure efficiency and accuracy • Initiate and maintain provider privileging for all provider types to ensure their credentials are up to date • Maintain up to date data for each provider in credentialing databases, such as Compliatric and other online systems • Ensure timely renewal of licenses and certifications • Initiate and maintain individual participating provider contracts with 15+ healthcare payor companies



Oloop Technology Solutions

• United States
• IT Services and IT Consulting
• 1 - 100 Employee

• Healthcare Risk Management Program Analyst

  • Jul 2020 - Nov 2020

  Served as a government contractor providing technical and analytical support in healthcare management and program analysis for the Office of Clinical Quality Management department with the Defense Health Agency • Analyzed data and built risk models to support risk programs and activities • Prepared reports to comply with clinical, environmental, and privacy compliance regulations in JCCQAS and CarePoint • Performed Adverse Actions case audits to ensure MTF is within due process timelines and adhering to protocols outlined in DHA PM and DoDM 6025.13



Greenbrook

• United States
• Mental Health Care
• 100 - 200 Employee

• Credentialing Specialist

  • Aug 2018 - Jul 2020

  Served as Team Lead for the Credentialing department overseeing a team of six people onsite and offsite • Researched and performed routine data analysis of credentialing processes to mitigate risks • Reported any risk findings and resolutions to colleagues and management for prompt action and resolution • Initiated group contracts for 40+ new and existing practice locations to various payors to obtain In Network status • Initiated and maintained provider contracts for initial and recredentialing submissions for 30+ Psychiatrists to manage In Network status with payors • Maintained and monitored tracking data for individual and group payor submissions via Salesforce, AthenaNet Health and CAQH to ensure that credentialing is completed in a timely manner • Troubleshot any credentialing issues that may arise



Insight Global

• United States
• Staffing and Recruiting
• 700 & Above Employee

• Credentialing Specialist

  • Feb 2018 - Aug 2018

  Served as a Credentialing Specialist for the Credentialing department at Greenbrook TMS NeuroHealth • Initiated group contracts for 40+ new and existing practice locations to various payors to obtain In Network status • Initiated and maintained provider contracts for initial and recredentialing submissions for 30+ Psychiatrists to manage In Network status with payors • Maintained and monitored tracking data for individual and group payor submissions via Salesforce, AthenaNet Health and CAQH to ensure that credentialing is completed in a timely manner • Troubleshot any credentialing issues that may arise



FavorTech Consulting/Innovative Information Solutions

• Arlington VA

• Credentialing Specialist

  • Jan 2017 - Dec 2017

  Served as a contract employee supporting the Department of Defense’s Army National Guard Office of the Chief Surgeon • Provided centralized credentialing and privileging services to initiate and maintain valid credentials for military medical providers • Assisted the Centralized Credentials Privileging Board’s review of completed credentials and privileging files for up to 150 providers per quarterly board review. • Maintained and validated over 150 providers’ credentialing documents to ensure licensures and certifications are up to date • Provided technical assistance in CCQAS to the providers guiding them on how to complete their eApps in the system



North American Partners in Anesthesia

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

• Senior Credentialing Specialist

  • Feb 2016 - Dec 2016

  Acted as Interim Department manager from mid-February 2016-May 2016. Liaison for staff and management for reporting of day-to-day progress and individual/group projects • Performed quality assurance/quality analysis of various department activities and projects to manage accuracy of data provided to management• Initiated and maintained provider privileging with various hospital-based sites to ensure their credentials are up to date• Utilized credentialing databases such as CAQH, NPDB, AMA, Cactus, National Student Clearinghouse, etc.• Responsible for credentialing activities for over 75+ Physicians and CRNA’s in accordance with internal policies, managed care guidelines, and other regulatory agencies such as NCQA, JCAHO, and CMS to ensure efficiency and accuracy

• Credentialing Specialist

  • Oct 2014 - Feb 2016

  Acted as Interim Department manager from mid-February 2016-May 2016. Liaison for staff and management for reporting of day-to-day progress and individual/group projects • Performed quality assurance/quality analysis of various department activities and projects to manage accuracy of data provided to management• Initiated and maintained provider privileging with various hospital-based sites to ensure their credentials are up to date• Utilized credentialing databases such as CAQH, NPDB, AMA, Cactus, National Student Clearinghouse, etc.• Responsible for credentialing activities for over 75+ Physicians and CRNA’s in accordance with internal policies, managed care guidelines, and other regulatory agencies such as NCQA, JCAHO, and CMS to ensure efficiency and accuracy



DKB Therapy, Inc

• Fredericksburg, Virginia, United States

• Human Resources Generalist

  • Jan 2014 - Oct 2014

  Served as the sole Human Resources Generalist for two behavioral health clinics • Prepared on-boarding documents for new staff/therapists at two practice locations to obtain pertinent documentation needed for employee files and payor credentialing submissions • Updated Clinician data in the credentialing database in the Council for Affordable Quality Healthcare (CAQH) system for 8 therapists to maintain accuracy of data • Submitted daily co-pay’s and patients’ Explanation of Benefits (EOB’s) into the QuickBooks system to assist the accountant’s quarterly reporting • Monitored and reported progress on each therapist’s credentialing status to management to determine their official start date • Processed and submitted credentialing applications for the individual therapists and the two group practice locations to various health insurance payors



Arlington National Cemetery

• Arlington, Virginia, United States

• Data Management Specialist

  • Aug 2011 - Dec 2012

  Quality Assurance/Quality Compliance Auditor, as a member of the congressionally mandated gravesite accountability taskforce, assists in the evaluation, analysis, reconciliation, validation, and identification of discrepancies within 100 years of data utilizing electronic records, photographs, data tables, and maps to establish the authoritative record of all burials at Arlington National Cemetery using the grave accountability system. • Performed as the QA/QC Team Lead, typically held by the Senior Data Management Specialist (GS-9) to manage the QA/QC team by assigning tasks, monitoring productivity and resolving issues and concerns with the data system and personnel issues to mitigate risks for the task force mission • Reviewed data applications and applied mathematical, statistical, and analytical methods to assist in validation of data being reported by the field and in office teams • Received the U.S. Army Commemorative Coin for Outstanding Performance from the Executive Director, Arlington National Cemeteries Program, Ms. Kathryn A. Condon, September 2011 • Received the U.S. Army Commemorative Coin for Selfless Service from The Secretary of the U.S. Army, The Honorable John McHugh, December 2012



Sparks Personnel Services

• United States
• Staffing and Recruiting
• 1 - 100 Employee

• Reimbursement Analyst

  • Jun 2009 - Jul 2011

  Contract employee for two pharmaceutical call centers, United BioSource Corporation and Parexel • Received heavy volume of inbound calls from healthcare professionals, patients, and sales representatives with inquiries regarding discount specialty drug programs and to report adverse reaction • Assisted with reimbursement inquiry requests from healthcare professionals and patients by verifying individual coverage of prescribed specialty medication • Verified patient insurance benefits via outbound calls to pharmaceutical programs to confirm specialty drug coverage • Resolved prior authorization issues and/or appeals of denials to obtain approval of non-covered medication • Identified complex cases and triaged them appropriately to the next level for review