Anna Kasaka

• Ensure all practitioner documentation complies with current federal regulatory requirements, including standards set by the Centers for Medicare and Medicaid Services (CMS), The Joint Commission, National Commission on Quality Accreditation, and program-specific guidelines. Maintain adherence to departmental policies and applicable laws and regulations.

• Prepare detailed written audit reports outlining file deficiencies and provide recommendations to the Clinical Chief, Credentials Committee, Medical Executives, and other stakeholders as appropriate. Recommendations may include training, oversight, monitoring, and process improvement strategies.

• Develop and deliver training and education sessions for new clinical leaders or departments managing credentialed practitioners or organizational providers, focusing on document review results, regulatory findings, and audit outcomes.

• Compare file content, privileges, and ongoing evaluation periods with regional and national benchmarks as well as regulatory and accreditation standards. Review queries related to Clinical Chief decisions, committee actions, or program denials.

• Investigate and resolve reports of file discrepancies, and communicate findings to the Credentials Supervisor and/or Director.

• Ensure timely dissemination of updates to regulations, policies, and guidelines to all affected personnel and stakeholders.

• Ensure the timely enrollment of new providers and facility sites, as well as the ongoing maintenance of existing providers and facility sites with payors.

• Initiate and complete enrollment for electronic claims submissions.

• Process new applications for individual practitioner and/or facility National Provider Identifier (NPI) via the National Plan and Provider Enumeration System (NPPES) and assist with all Provider Enrollment-related applications.

• Respond to internal and external inquiries, conduct research, and resolve issues efficiently.

• Review charges, claims pending reports, and claim edit work queues in EHR/EMR systems to ensure accuracy and compliance.

• Complete tasks within established timeframes to meet departmental standards and payor deadlines.

• Handle inbound and outbound calls to address customer concerns and provide timely follow-up.

• Offer personalized consultations on health-related products and services, ensuring optimal solutions for customers’ health and financial needs.

• Manage and maintain accurate customer accounts and information.

• Respond to customer inquiries with empathy, active listening, and a focus on delivering efficient, tailored solutions.

• Troubleshoot and resolve technical issues with patience and a customer-centric approach.

• Proactively identify additional customer needs and recommend appropriate upgrades to products or services.