Experience

Charlotte Eye Ear Nose & Throat Associates, P.A. (CEENTA)
• United States
• Hospitals and Health Care
• 300 - 400 Employee
• Credentialing Manager

  • Mar 2022 - Present


Metrolina Nephrology Associates, PA

• United States
• Medical Practices
• 1 - 100 Employee

• Credentialing Coordinator

  • Jul 2018 - Feb 2022

  • 20+ years of experience in provider onboarding, support, and account maintenance with recognized strengths in establishing and maintaining business relationships with credentialing coordinators, contracting departments, medical management, and payer contacts. Resourceful and dependable professional capable of working and communicating with all levels of the organization & delivering under aggressive deadlines while maintaining accuracy and attention to detail. • Applications: VerityStream, Maestro Care (EPIC), MS Excel, MSWord, MS PowerPoint, MS Access, MS Outlook, IDX, TES, BAR, Echo, Allscripts, Cisco Jabber, Perfect-Serve PROFESSIONAL EXPERIENCE Metrolina Nephrology Associates, PA Credentialing Coordinator 7/2018 – Present • Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility. • Identifies issues that require additional investigation and evaluation, validates discrepancies, and ensures appropriate follow up. Contact practitioners to clarify discrepancies. • Prepares credentials file for completion and presentation to the Credentialing Committees, ensuring file completion within time periods specified. • Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions. • Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise. • Monitors the initial, reappointment and expiring processes for all Medical staff, Allied Health Professional staff, ensuring compliance with regulatory bodies. (CAQH, CMS, and DEA) Show less



Colonial Family Practice

• United States
• Pharmaceutical Manufacturing
• 1 - 100 Employee

• Credentialing Specialist

  • Jun 2017 - Feb 2018

  Compiles and maintains current and accurate data for all providers; Completes provider credentialing and recredentialing applications; monitors applications and follows-up as needed; Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers; Maintains corporate provider contract files; Maintains knowledge of current health plan and agency requirements for credentialing providers; Sets up and maintains provider information in online credentialing databases and system; Tracks license and certification expiration for all providers to ensure timely renewals; Ensures practice addresses are current with health plans, agencies and other entities; Processes applications for appointment and reappointment of privileges of physicians and providers; Tracks license, DEA and professional liability expiration for appointed providers; Maintains confidentiality of provider information; Provides credentialing and privileging verification; Other billing/insurance department duties as assigned. Show less



Duke University Health System

• Hospitals and Health Care
• 700 & Above Employee

• Provider Enrollment Specialist

  • Oct 2005 - Jun 2017

  Process enrollment for providers, individual and group application submissions to various governmental carriers; Manage the submission and completion of provider enrollment applications; Assist providers by applying for individual and organizational National Provider Identifier numbers; In depth knowledge of all specific application requirements for each payer including pre-requisites, forms required, form completion requirements, supporting documentation (DEA, CV, etc.), and regulations; Performs follow-up with insurance payers via phone, email or website to resolve provider enrollment issues; Maintain documentation and reporting regarding provider enrollments in process; Retain and maintain all completed provider on-boarding enrollments; Maintain and submit provider directory to managed care carriers for Delegated credentialing via Access; serve as liaison between the physicians and the PRMO concerning billing issues; Follow up and research third party denials with the Billing and Collection Department; review and manage the patient account receivables and work with the physicians Collections Department to reduce outstanding debts and troubled accounts; research and maintain provider information in ECHO and IDX; Create spreadsheets for tracking governmental group applications utilizing Excel; Obtain and verify required credentials and licenses Show less



PhyAmerica Physician Services

• United States

• Provider Enrollment Team Leader

  • Dec 1998 - Jun 2004

  Researched and maintained provider information utilizing IBM AS/400 Application Software; Administrative oversight of the Enrollment process for a defined territory, including governmental and managed care enrollment before new providers worked their first shift; Provided hands-on training to team members, responded to questions and strategized on various enrollment scenarios; Assisted AVP of enrollment with hiring and placement of new Enrollment Coordinators; Reviewed and strategized with team members and Healthcare Business; Resources to reduce and maintain minimal paperwork pending holds Show less