Experience

Chartis Clinical Quality Solutions

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

• Interim Medical Staff Credentialing Consultant

  • Dec 2019 - Present

  • Perform administrative and technical duties to support the credentialing functions of initial appointment, reappointment, the granting of clinical privileges, and maintenance of expired credentials in accordance with hospital medical staff bylaws and credentialing policies and procedures • Assist 3rd oldest general hospital in the USA with migrating, merging and centralizing multiple facilities. Processing credentials for high volume, fast paced health system of 7,000+ health care providers and clinical trainees. • Work to ensure that timely and accurate initial and reappointment applications are presented to the department chairs/credentials committee/medical executive committee for review • Populate, maintain, and update credentialing software including accountability for the integrity of credentialing information entered into the credentialing system • Identify, investigate, report, track, and follow-up on all potentially adverse information received from credentialing sources according to established guidelines and hospital credentialing policies and procedures • Communicate appointment, reappointment, and clinical privilege decisions and changes to any external and internal parties as directed and in accordance with credentialing policies and procedures Show less



CEDARGATE HEALTHCARE GROUP, LLC

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

• Credentialing Specialist

  • Apr 2019 - Dec 2019

  • Ensure CVCP network consists of qualified physicians and allied health professionals through the credentialing process by reviewing applications for network participation; continuous evaluation of the program’s effectiveness; provide accurate and timely credentialing information to the managed care organizations and payers with whom CVCP contracts. • Verify medical credentials such as license, DEA, education/training, and medical liability insurance via primary source verification to ensure minimum standard of network participation criteria is met while maintaining compliance with NCQA accreditation standards. Show less



United Memorial Medical Center

• Hospitals and Health Care
• 100 - 200 Employee

• Credentialing Manager

  • Aug 2016 - Aug 2018

  Oversee, manage, and coordinate all components of the Medical Staff office. Establish workflow priority for the Medical Staff Department. Directs and supervises the daily functions of the Credentialing Assistant providing counseling, training, and prioritizing workflow. Serve as liaison between Administration, practitioners, and healthcare facilities. Maintain medical staff Re-appointments for members of the Medical staff and initiate the credentialing process for new providers requesting clinical privileges and medical staff membership in accordance with Compliance regulatory and accreditation guidelines. Communicate effectively with Administration, Quality, and other Medical Staff leadership to resolve issues relative to credentialing. Facilitate Credentialing Committee, Medical Executive Committee, and Board meetings. Audit all material produced from the Medical Staff Services Department. Show less



Cypress Fairbanks Medical Center Hospital

• Hospitals and Health Care
• 1 - 100 Employee

• Medical Staff Credentialing Coordinator

  • Sep 2014 - May 2016

  Responsible for the operational and administrative requirements of the Medical staff department Process applications and documents to ensure applicants meet the criteria of the Hospital requirements Conduct thorough background checks and employee verification's. Research and primary source verify all components of the applicants file while identifying issues that require additional investigation, validate discrepancies and ensure appropriate follow up Maintain confidential staff records. Coordinate orientation for new staff members. Coordinate, manage, and maintain all Medical Staff department meetings as well as record and transcribe minutes Adhere to and enforce all Hospital policies and procedures Show less



American Surgical Professionals

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

• Credentialing Specialist

  • Feb 2014 - Sep 2014

  Manage credentialing functions for 150+ Surgical Assistants across the Region. Coordinate all aspects of the credentialing and primary source verification process for Surgical Assistants according to policy and procedures. Process initial and re-credentialing applications, complete data entry of applications, review for errors prior to submitting for review and approval. Manage credentialing functions for 150+ Surgical Assistants across the Region. Coordinate all aspects of the credentialing and primary source verification process for Surgical Assistants according to policy and procedures. Process initial and re-credentialing applications, complete data entry of applications, review for errors prior to submitting for review and approval.



St. Luke's Episcopal Health System

• Houston, TX

• Senior Credentialing Coordinator

  • Aug 2011 - Mar 2013

  Maintain physician staffing privileges Reappointments and Continue Medical Education courses Administer/monitor physician malpractice insurance Verify physician credentials through Texas Medical Board Request provider identification numbers via health plan/payors Obtain physician current status and board certification Make sure Texas Standardized Credentialing Application is current. Apply for medical license, national provider identification number, Tax identification number, Texas Department of Public Safety registration number, Drug Enforcement Administration number. Maintain physicians personnel records Show less



Apogee Physicians

• United States
• Hospitals and Health Care
• 300 - 400 Employee

• Credentialing Specialist

  • Jun 2009 - Aug 2011

  Coordinate credentials for physicians and Allied Health providers Pre-fill and submit hospital credentialing applications Apply for physician state medical license nationwide Submit renewals for DEA and state Narcotics registration Maintain Texas State Credentialing application for each physician Work closely with the Medical Staff office and interact directly with the health care providers to ensure all credentials are current and verified Correspond with the State Medical licensing board to ensure the application process flows thoroughly. Make follow up calls to ensure verifications are turned around in a timely manner, and license are issued Show less



AMN Healthcare Physician Solutions

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

• Senior Credentialing Specialist

  • Aug 2007 - Jun 2009

  Medical staffing company that recruits healthcare professionals and places them in variable lengths of assignments and locates permanent positions for various healthcare settings. Ensure all Anesthesia/Surgery health care providers meet requirements necessary to obtain privileges at hospital facilities in a timely manner and meet credentials standards for continued participation Preparae correspondence associated with the credentialing process Pre-filling applications submitting background checks, Prime source verification verifying credentials. Provide follow up on progress of application flow Coordinate and prepare reports pertaining to existing Practitioners Act as liaison between practitioner and related entities (hospitals, malpractice insurance agency, billing companies) within the credentialing process Work closely with Recruiters from talent sourcing to the hiring process Comply with all HIPPA/JCAHO rules and regulations Show less