Associate Credentialing Manager - Epic Government (formerly FSR) - Annapolis, MD
(2023-03)
- Credential physicians, allied health professionals, and nurses for military bases and state agencies
- Maintain credentialing files with less than 1% return rate
- Complete and submit facility applications and ensure compliance with Joint Commission, CMS standards
- Led monthly meetings and maintained strong physician relationships
- Perform primary source verification (PSV) for licenses, education, and certifications for all providers
- Completed Background for all new hires and also for recredentialing
- Monitor license expirations and ensure timely renewals
- Conduct NPDB, OIG, NSO, and Tricare sanctions checks
- Verified Malpractice and history of claims
- Obtained Clinical References
- Verified up to 10 years of employment/affiliations
- Coordinate drug screenings and onboarding requirements
- Scheduling Fingerprints, Medical Requirements
- Train new team members and develop SOPs and Training Guides
- Perform file audits and maintain 100% audit compliance for Company and Joint Commission
- Conduct employment verifications and obtain clinical references
- Provide coaching and performance support to staff
- Ensure Credentialing Team meets or exceeds KPIs
- Lead Credentialing Committee Privileging Meetings
- Weekly 1:1 with each Credentialing Specialist
Lead Credentialing Specialist - SOH Dental - Chesterfield, MO
(2021-01 - 2023-03)
- Managed provider enrollments with multiple insurance companies
- Completed new enrollments and re-credentialing applications
- Maintained licenses including DEA, CDS, malpractice, and CAQH profiles
- Negotiated insurance fee schedules and resolved payment issues
- Ensured providers were fully credentialed prior to patient care
- Set up EFTs and monitored enrollment statuses
- Generated reports and tracked application progress
- Trained staff on insurance policies and procedures
Practice Manager of Operations - Heartland Dental - St. Louis, MO
(2016-05 - 2018-11)
- Managed daily operations, scheduling, and staffing
- Supported credentialing compliance and license tracking
- Oversaw billing, insurance posting, and accounts receivable processes
- Analyzed P&L reports and implemented strategies to meet financial goals
- Led hiring, onboarding, and payroll submission
- Reduced insurance aging and improved collections processes
- Coordinated patient financial plans and insurance verification
- Coached and mentored team members to improve performance
- Developed team incentives and maintained high engagement
Accounts Receivable Specialist - Southern Medical Corporation - Baton Rouge, LA
(2009-11 - 2015-10)
- Posted insurance and patient payments and charges
- Managed insurance reports and appeal processes
- Worked with ICD-9/ICD-10 and CPT coding
- Handled patient communications and financial arrangements
- Prepared accounts for collections and maintained aging reports
Credentialing Specialist - Lake Surgery Center - Baton Rouge, LA
(2004-01 - 2009-10)
- Managed full credentialing lifecycle for providers and medical staff
- Verified licenses, DEA, CAQH, PECOS, and malpractice coverage
- Conducted NPDB queries and primary source verifications
- Obtained References required for Credentialing and ReCredentialing
- Prepared files for credentialing committee approval
- Ensured compliance with CMS and AAAHC guidelines
- Assisted with patient registration as needed
