Credentialing

Kristie Holliman

**** ***** ****** **, ****** TN ac044n@r.postjobfree.com 615-***-****

WORK EXPERIENCE

Provider Operations Coordinator

WellCare Health Plans, Inc., Franklin, TN- December 2016 to present

Support the Provider Relations Field Reps to resolve claims and payment issues.

Answers incoming telephone inquiries from providers and assist with problem resolution of issues.

Root cause analysis of operational and health service issues.

Review and process incoming and outgoing paperwork, including directory updates, provider credentialing applications, delegation groups, contract maintenance forms and other related forms.

Track new contracts through sidewinder.

Audits configuration loads on new contracts.

Provide office, project management, provider recruitment and data analysis support.

Assist with Special Projects

Credentialing Specialist

Community Health System/Credentialing Verification Services (CVS)- Franklin, TN – December 2015 to November 2016

Responsible for Credentialing &Recredentialing identified providers and mid- levels with Government payors (Medicaid/Medicare) and managed care plans.

Monitor Credentialing to assure providers and mid-levels are credentialed according to CVS established practices and guidelines, and NCAQ Standards.

Perform primary source verification on required documents including but not limited to NPDB, licensing boards, ABMS, OIG, and GSA.

Managed the completion of enrollment and submission of applications for Government and non- delegated payors, perform tracking and follow up of these application completion.

Coordinate effective communication between all parties for notification of completion of assigned applications.

Credentialing Coordinator

Community Health Alliance - Brentwood, TN - August 2015 to November 2015

Responsible for Credentialing vendor oversights and the credentialing of all CHA participating providers.

Follow-up with practitioners/facilities when files are incomplete.

Process, track and file credentialing applications within established standards

Comply with CHA's Credentialing Policies and Procedures.

Respond to internal and external customer inquiries regarding credentialing status.

Ensure the credentialing database remains up to date and accurate.

Participate in the monthly Patient Safety Committee meetings and work with CMO on weekly clean file

approvals.

Record, update and forward the PSC meeting minutes to manager, and medical directors.

Conduct onsite and desktop delegation audits for CHA delegates.

Manually add newly approved providers to a spreadsheet in order to update database weekly.

Forward any changes//terms to correct person for termination in database.

Assist with other provider relations responsibilities.

Credentialing Coordinator

Capstone Pediatrics - Smyrna, TN - June 2015 to September 2015

Maintained reappointments for all medical doctors, professional counselors, nurse practitioners with their

hospital affiliations.

Update providers, nurse practitioners, professional counselors CAQH applications.

Send out welcome packets to all newly staff providers, nurse practitioners, and professional counselors.

Assign CAQH numbers and complete new applications for new staff members.

Completed paper apps on behalf of the providers and sent to the insurance carriers.

Reach out to insurance carriers to verify previous malpractice coverage and to assignnew coverage.

Provide insurance carriers with the current licensures, professional liability insurance, DEA, etc.

Handle calls pertaining to provider's credentialing.

Maintained and updated the credentialing database with new information.

Work as a consultant, handling credentialing, afterhours once I transferred to new company.

Credentialing Coordinator

Cigna Healthspring - Nashville, TN - June 2014 to May 2015

Complete the initial and recredentialing of providers to maintain compliance with NCQA and Cigna Healthspringstandards

Gather Primary Source Verification information

Reach out to State Medical Boards for any discrepancies pertaining to licensures

Communicate with internal depts along with provider office's with credentialing questions regarding the statusof their credentialing applications

Maintain recredentialing 36 month compliance turnaround

Assist supervisor with other projects for the department

Recredentialing Team Lead

Windsor Health Group - Brentwood, TN - February 2008 to May 2014

Act as Team Lead in the Credentialing Department for all Analyst and Sr. Analyst assigned to Recred team

Establish workflow priorities for the Recred Credentialing team

Create, manage and monitor various spreadsheets for the provider’s upcoming recredentialing cycle

Generate various spreadsheets for the CVO vendor

Assist with credentialing and recredentialing provider’s applications

Provide input to the development of policies, procedures, various vendors for paperless, and processes

Assist w/ organizing and outlining the Medical Advisory Committee monthly reports.

Attend Credentialing Medical Advisory Committee and other committee meetings as necessary

Respond to inquiries from Network Services/Provider Services regarding the status of provider applications

Assist with training and transitioning department to paperless.

Work with other Team Leaders to manage major projects

Assist Supervisor, when necessary, with internal audits which will include the audit of all new credentialingcoordinator provider files until 98% accuracy reached and the retraining of any noted trends identified throughthe internal audit process for all credentialing coordinators

Assist the Supervisor and/or Director on assignments; identify problems and/or opportunities for the team

Train new employees on credentialing processes as needed

Participate on biweekly meetings with the CVO vendors

Conduct biweekly re-credentialing team meetings with staff

Interviewed potential candidates for the Credentialing Team

Sr Credentialing Analyst

Windsor Health Group - Brentwood, TN - December 2006 to January 2008

Maintain all credentialing/recredentialing files and databases

Assist with credentialing and recredentialing organizational applications

Process applications and generate necessary correspondence to obtain required documentation

Audit outsourced credentialing files and work with company representatives on file issues

Assist internal departments with credentialing questions and/or providers with questions regarding the statusof their credentialing applications

Attend credentialing committee meetings as needed

Special projects as assigned by the Credentialing Manager or the Team Leader

Performed monthly departmental quality review

Develop and maintain credentialing policies and procedures to ensure compliance with Accreditations andRegulatory standards (NCQA and CMS guidelines)

Member of the TAMMS (TN Association of Medical Staff Services)

Credentialing Specialist

Concentra Network Services - Franklin, TN - July 2005 to November 2006

Ensure that all applicants for participation have met state regulatory and Concentra guidelines.

Perform quality review on all applications, completed by outside vendors and/or internal credentialer, foraccuracy as well as for questionable clinical and business issues.

Contacted provider and/or State Medical Board for any explanation of discrepancy or sensitive information

Verify questionable information and directed the applications appropriately through the remainder of the

credentialing process.

Presented, discussed, and reviewed all applications with the Credentialing Committee to determine the

provider participation status.

Assist on Special Projects (TX EPN, OIG Exclusion, CA MPN, State Licenses, Med Advantage, Phoenix

Cred Letters, etc)

Participated on the Policies & Procedures Committee, with reviewing and revising all policies within the

company before implementing them

Sr. Customer Service Representative

Verizon Wireless - Murfreesboro, TN - February 2004 to July 2005

Handled high volumes of inbound customer calls

Researched and resolved billing inquiries for customers in the NE and MW area

Assisted in the Supervisor Queue for any major issues

Explained products and services, troubleshoot equipment, order phones and accessories.

Assist on different projects (Follow Ups, Partial Bill Scripting, and Transactional Audits) to help meet call center standards.

Recognized and promoted to Senior. Rep in Sept. 04.

Received Top Performer for the MW Area for Apr and May 05.

LNP Consumer Customer Service Representative

Verizon Wireless - Murfreesboro, TN - October 2003 to March 2004

Assist customers with questions pertaining to porting number to and from Verizon Wireless.

Created and Completed port requests

Worked with other carriers (Sprint, Nextel, Cingular, Alltel, etc) with providing/receiving feedback on port

issues/status

Assisted with answering Customer Care questions

Was recognized by Quality for Good Overall Call, 2003

Credentialing Assistant/Specialist

Cigna Healthcare - Franklin, TN - January 2000 to March 2003

Complete re-credentialing process in compliance with NCQA and Cigna standards for Knoxville and Memphisproviders.

Monitored and recorded several spreadsheets with 1,635 Knoxville providers and 454 providers in Memphis.

Mailed re-credentialing applications to providers in Nashville, Knoxville, Memphis, Chattanooga, Arkansas,and Kentucky

Circle of Excellence Award for Exceeding Job Description, 200

Clerical Associate

Cigna Healthcare - Franklin, TN - November 1997 to December 2000

Recorded data information in the system and distributed to representatives.

Handled service calls/issues on printers and fax machines.

Assisted/backup for supervisor when available/not available

Received the Circle of Excellence Award for going above and beyond job expectations, 1998.

EDUCATION

Business Management

Nashville State Technical Institute - Nashville, TN1998 to 2000

Centennial High School - Franklin, TN1997

ADDITIONAL INFORMATION

Many years of experience in the Healthcare and Customer Care industry.Exhibits professionalism,positive team spirit and precision in completion of assigned tasks.Honored by peers for cooperative spiritand dedication to team goals.Organized with computer competencies that include MSWord, Outlook, Excel,Sharepoint, Cactus, OmniFlow, SalesForce, Lotus Notes 7, WordPerfect, Access, I2K, Web Station, PRISM, PowerPoint, Symed, TimeStar, Vistar, MD-Staff, UltiPro and Xcelys.

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