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Click here or scroll down to respond to this candidateCandidate's Name
Peoria, AZ PHONE NUMBER AVAILABLEEMAIL AVAILABLECREDENTIAL MANAGERResults-driven and highly motivated Credentialing Manager with extensive industry experience driving strategic contracts and successfully managing implementation contracts. Proven record of identifying business impacts and quality as both Manager and Analyst. Clear communicator who consistently operates at an optimal performance level to support organizational processes while fostering trust and building relationships with clients, peers and leadership to achieve individual and departmental goals.KEY SKILLSLeadership Vendor Management Contract Contract Credentialing Processing Process Improvement Product Management Software Development Business Intelligence Mercy Care Medicare Web Services Provider Management Quality AssurancePROFESSIONAL EXPERIENCEEllie Mental Health Phoenix, AZ (virtual) October 2023 April 2024Credentialing ManagerCollaborated with key partners across the enterprise to ensure timely delivery of credentialing projects and contract completion with minimal customer disruption as new network services and capabilities are launched.Addresses emergent department issues relating to high-risk credentialing, shortened turnaround times, and provider onboarding.Participated in Managed Care, Joint Commission, and state audits.Ability to analyze and interpret provider contracting and communicate contract fee schedules and terms.Understanding of reimbursement methodologies and payment models in healthcare.Ability to collaborate with internal and external shareholders and constituents to achieve credentialing goals.Ability to adapt to changing regulations and industry trends in healthcare contracting and credentialing.Aetna Phoenix, AZ (virtual) September 2008 October 2023Credentialing AnalystConducted thorough credentialing analysis for newly hired medical staff and existing medical providers to ensure compliance with industry regulations and internal policies with a successful onboarding rate of 98%.Managed onboarding screening process utilizing state and federal verification systems.Verify and confirm medical staff credentials, certifications, and licensures are current and active.Coordinates and conducts provider coaching and presentations.Supported the performance management team by evaluating credentials and utilizing information to promote market growth opportunities.Served as the primary point of contact for providers and employees regarding credentialing certifications and requirements, contracted agreements, and providing guidance and support for general national market questions.Collaborates cross-functionally with teams, such as legal and compliance, to ensure all providers maintain appropriate credentials, certifications, and liability coverages.Assists with provider relation matters, including investigative and resolving credential-related disputes or complaints. Ensures medical staff and providers are practicing best practices and investigates any insurance claims against medical staff.EDUCATIONWalden University- MBA JuneGrand Canyon University- B.S. Business Marketing |
