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Teri Berthiaume
Coon Rapids,MN
Summary
Experienced with credentialing processes and regulatory compliance. Utilizes effective communication and meticulous documentation to manage credentialing for healthcare providers. Knowledge of industry standards and best practices ensures thorough and efficient credentialing operations.
Credentialing professional with solid expertise in managing and verifying credentials for healthcare providers. Strong focus on team collaboration and achieving results. Reliable and adaptable, meeting organizational standards and compliance requirements. Skilled in data management, regulatory compliance, and communication.
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
25
25
years of professional experience
Work History
Credentialing Specialist
Ellie Mental Health
01.2023 - 11.2024
- Complete credentialing applications online for review and analysis of practitioner's data information, and enclosed documents ensuring applicant meets company guidelines and eligibility
- Verify the provider's data, sets up files to complete the initial, re-credentialing and expiring documents for their credentialing process
- Utilizes various websites, contacts educational facilities and professional references to verify credentials
- Ensures compliance with facility Medical Staff Bylaws, Rules and Regulations, policies, and procedures
- Send Add/term forms to payers
- Collaborated with healthcare providers to gather necessary information for accurate credentialing decisions.
- Managed multiple priorities effectively, resulting in the on-time completion of credentialing tasks for numerous providers simultaneously.
- Enrolled providers and Medicaid, Medicare, and private insurance plans.
Medical Staff Coordinator
Prairie Care Medical Group
01.2022 - 01.2023
- Coordinate medical Staff privileging and credentialing applications
- Complete annual FPPE, OPPE, and related processes for accreditations for Joint Commission
- Taking medical staff department meeting minutes
- Prepare Medical Staff Committee meetings minutes, completing provider binders for the meeting
- Updated job descriptions for all medical personnel, contributing to consistent performance evaluations across departments.
- Facilitated successful transition during mergers or acquisitions through seamless integration of new team members into existing staffing structure.
- Streamlined credentialing processes for faster onboarding of new medical staff members.
- Developed tracking systems for mandatory licensure renewals, maintaining 100% compliance among medical personnel.
- Ensured compliance with regulatory standards by conducting regular internal audits of departmental policies and procedures.
- Enhanced patient care by coordinating medical staff schedules and ensuring adequate coverage at all times.
- Organized regular training sessions for administrative support staff, increasing efficiency within the department.
- Contributed to facility accreditation efforts by preparing necessary documentation and coordinating site visits from accrediting agencies.
- Reduced errors in documentation by implementing a thorough auditing process for medical staff records.
- Expedited credentialing applications, enabling timely commencement of clinical services by newly hired physicians.
Hospital Credentialing Coordinator
Fairview Health Services
01.2018 - 01.2022
- Complete Primary Source Verification on all required documents set by Joint Commission and NCQA
- Processing Privilege Forms for Competency, accurate documentation received
- We use a lot of Critical Thinking while reviewing the verifications received
- Increased efficiency in data management by implementing a user-friendly database system for storing provider information.
- Improved turnaround times for processing credentials by diligently reviewing and verifying provider eligibility.
- Expedited the onboarding process for new medical staff by efficiently managing initial appointments and reappointments.
- Worked closely with practitioners to help each obtain privileges at assigned healthcare facilities
- Tracked expiration dates on documents and communicated with appropriate staff to avoid late filing.
Credentialing Coordinator
Preferred One
01.2000 - 01.2018
- Load and maintain databases, accurately entering or importing data in appropriate formats in a timely manner
- Review of incoming applications for completeness and accuracy
- Communication and follow-up with providers and clinic personnel to complete and expedite the credentialing process
Education
General Education Diploma - Associate of Science Degree in Medical Billing and Coding
Colorado Technical University
Skills
- HIPAA compliance
- Background checks
- Provider enrollment
- Data management
- Credentialing oversight
- Application coordination
- Database maintenance
- Accreditation information management
- Facility credentialing
- License verifications
- Credential verification
- Solo practitioner credentialing
- Community health center credentialing
- Credentialing documentation
- Microsoft office
- Documentation and recordkeeping
- Information protection
- Procedure compliance
Accomplishments
Accomplished professional with 20 years of expertise in credentialing and medical staff coordination across leading healthcare organizations. Demonstrating proficiency in enrollment processes, insurance compliance, and ensuring adherence to Joint Commission and NCQA Standards. Proven track record in healthcare provider verification, leveraging strategic communication and problem solving skills to drive operational excellence.
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Software
MAC
Excel
Powerpoint
Timeline
Credentialing Specialist
Ellie Mental Health
01.2023 - 11.2024
Medical Staff Coordinator
Prairie Care Medical Group
01.2022 - 01.2023
Hospital Credentialing Coordinator
Fairview Health Services
01.2018 - 01.2022
Credentialing Coordinator
Preferred One
01.2000 - 01.2018
General Education Diploma - Associate of Science Degree in Medical Billing and Coding
Colorado Technical University
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