Ashley Patterson
Nellore,AP
Summary
Experienced Provider Credentialing Specialist with five years experience. Excellent skills in analyzing data and paying attention to details. Team oriented with the ability to lead initiatives and manage change through great verbal and written communication.
Overview
9
9
years of professional experience
Work History
BacKground check coordinator
ShiftMed
01.2022 - Current
- Onboarding of initial Nurse recruitments
- Review credentialing documents
- Verify background check Forms for processing
- Process background checks based on state Requirements
- Data entry
- Assist with other credentialing dUties, as needed.
CREDENTIALING SPECIALIST
PLANNED SYSTEMS INTERNATIONAL
05.2020 - 10.2021
- Ongoing monitoring and maintain databases with HCP licenses and certifications
- Provide monthly reporting on credentialing status, communication issues, roadblocks, and concerns
- Monthly file posturing for board presentation
- Ongoing tracking of fee based primary source verifications
- Monthly tracking of potential excom/ sanctioned providers
- Audit/ensure accuracy of files before submission for board presentation.
Credentialing Specialist
MyEyedr
06.2019 - 01.2020
- Team lead duties
- Responsible for training team members on software and auditing assistants completed assignments
- Verification of Sanctions/Exclusions
- Manage Credentialing Acquisition Process and onboarding of all new hire Optometrist and entering all providers into workflow system
- Apply for location National Provider Identifier (NPI)
- Provide weekly reporting on credentialing status, communication issues, roadblocks, and concerns
- Validate licensing information, obtain branch licenses as needed, and notifying state boards as required
- Audit/Ensure completeness of files before releasing
- Updating credentialing systems and Council for Affordable Quality Healthcare including location changes
- Manage Clinical Laboratory Improvement Amendment (CLIA) licenses as needed
- Coordinate Provider dues, and Continuing Education reimbursements
- Management of location application batches in credentialing software
- Project Manager for Credentialing software implementation and training
- Communicate with internal support for credentialing software issues
- Maintain current knowledge of credentialing software releases and functionality to determine how to integrate into Managed Vision Care (MVC) workflow
- Weekly Acquisition and new hire status report
- Approval and termination reports
- Credentialing liaison with Professional Services and Human Resources.
Credentialing Specialist
managed consultants for affiliated physicians
08.2018 - 06.2019
- Upon employment, I was tasked with resolving a Two-year-old medical claim denial for one of the group’s Neonatologists
- Through personal investigation of the medical claim, I discovered, the provider had been falsely suspended from the insurance payors network
- Within six months of my employment, through verbal and written correspondence, I was able to recoup approximately $27,000 through the claim appeal process
- Managed initial and re-credentialing duties for multi-specialty pediatric group
- Provider Enrollment and re-validation processes for hospitals and insurance payors
- Onboarding of all Medical Doctors (MD’s), Physician Assistants (PA’s), Neonatal Nurse Practitioners (NNP’s), Nurse Practitioners (NP’s)
- Assist new graduates with NPI, state license, and Drug Enforcement Administration (DEA) applications
- Data entry of provider information within the provider enrollment applications and other supporting documents into multiple payor systems via fax and internet
- Work with payor customer services to identify and resolve provider enrollment holds
- Ongoing monitoring of license, and DEA renewals
- Claim appeal submissions via verbal and written communication
- Maintain provider and group CAQH accounts
- Manage all aspects of appointment and reappointments of medical staff affiliated with Inova Fairfax Hospital, Inova Fair Oaks Hospital and Inova Loudoun Hospital.
Credentialing Specialist
anthem
03.2017 - 07.2018
- Re-credentialing duties for multiple specialty medical providers and facilities
- Re-verification of licenses and certifications based on state and federal requirements
- Primary source verification for education, board certifications, state licenses, CLIA, DEA, and CSR certifications
- Sanction and exclusion reporting through NPDB research
- Notify state boards, as required
- Outreach for missing provider/facility elements via fax, phone, and email communication
- Maintained monthly goal of 350 – 400 completed provider files
- Maintained quality assurance requirements of ≥ 90%
- Update provider records as needed.
Credentialing Assistant
anthem
08.2015 - 03.2017
- One year into my employment, I was assigned the task of research a new state Anthem was going into business with
- I was responsible for working with employees of the Iowa Health plan to determine what their state requires for all medical professionals as it pertains to licenses and certifications
- Determining online sites and internal software used for identifying state and federal sanctions and exclusions
- Credentialing Application Management Team
- Process initial credentialing applications for multiple provider specialties for a participating network status
- Assist with monthly program integrity research of sanctioned and excluded medical providers on a state and federal level
- Ongoing monitoring of licenses and certification based on specialty, state and federal requirements
- Ensure initial credentialing applications contain correct data and documentation required for approval
- Update provider records as needed.
Education
Criminal Justice
Delaware state university
01.2006
Skills
- JCCQAS
- MedChart
- Modio
- Facets
- Citrix
- Cactus
- Microsoft Office
- 65 WPM
- Pays attention to detail
- Team oriented
- Self-motivated
Security Clearance
Public Trust 2020- CURRENT
Timeline
BacKground check coordinator
ShiftMed
01.2022 - Current
CREDENTIALING SPECIALIST
PLANNED SYSTEMS INTERNATIONAL
05.2020 - 10.2021
Credentialing Specialist
MyEyedr
06.2019 - 01.2020
Credentialing Specialist
managed consultants for affiliated physicians
08.2018 - 06.2019
Credentialing Specialist
anthem
03.2017 - 07.2018
Credentialing Assistant
anthem
08.2015 - 03.2017
Criminal Justice
Delaware state university