Brandi Dickinson
Lubbock,TX
Summary
Skilled Credentialing Professional with expertise in managing healthcare provider and facility credentialing processes. Specializes in provider enrollment and contract negotiations, with a solid understanding of government and commercial payer networks. Delivers efficient credentialing operations through strong organizational skills and effective communication to enhance operational success.
Overview
1
1
Certification
12
12
years of professional experience
Work History
Senior Credentialing Specialist
MSI-RCM / Brookline Community Mental Health Center
Brookline, MA
10.2022 - Current
- Third party contracted to handle provider onboarding, individual enrollment & group contracts for outpatient community mental health clinic & neuropsychological testing facility. The clinic consisted of 50 behavioral health providers located in Brookline Massachusetts
- Collected confidential provider documents & managed secured online clinic & provider file system.
- Create & maintain provider CAQH profiles.
- Prepare and submit initial group & individual enrollment applications to commercial & government payers.
- Obtain approvals for initial individual enrollments & group contracts.
- Complete required revalidation/recredentialing requests to maintain network participation & renew contracts.
- Completed roster additions, updates, terminations & corrected discrepancies.
- Completed required provider demographic & directory verifications for group & individuals.
- Managed & maintained payer portal accounts (CMS, PECOS, Availity, etc.)
- Track and manage provider expirables, renewal timelines, provider type changes & license updates.
- Managed multiple priorities effectively, resulting in the on-time completion of credentialing tasks for numerous providers simultaneously.
Credentialing Specialist
Lubbock Family Medicine
Lubbock, TX
01.2019 - 09.2022
- Credentialing contractor for local family medicine clinic.
- Handled provider onboarding, collected & managed confidential provider documents
- Create & maintain provider CAQH profiles.
- Prepare and submit initial group & individual enrollment applications to commercial & government payers.
- Obtain approvals for initial individual enrollments & group contracts.
- Complete required revalidation/recredentialing requests to maintain network participation & renew contracts.
- Completed roster additions, updates, terminations & corrected discrepancies.
- Completed required provider demographic & directory verifications for group & individuals.
- Maintained payer portal accounts (CMS, PECOS, Availity, etc.)
- Track and manage provider expirables & renewal timelines. Processed status changes, terminations, and reactivations.
Credentialing Specialist
Physicians Unity/Wound Centrics
Lubbock, TX
02.2018 - 09.2022
- Employed as full time Credentialing Specialist for advanced inpatient & outpatient wound care program management & hyperbaric oxygen therapy practice. The group practice consisted of 70 multispecialty providers across 14 states.
- Handle provider onboarding, collect confidential provider documents & maintain provider file system in credentialing database.
- Prepare and submit initial group & individual enrollment applications to commercial & government payers.
- Obtained approvals for initial individual enrollments & group contracts
- Completed required revalidation/recredentialing requests to maintain network participation & renew contracts.
- Create & maintain provider CAQH profiles.
- Maintained payer portal accounts (CMS, PECOS, Availity, etc.)
- Completed required provider demographic updates & directory verifications.
- Migrated existing credentialing database to new credentialing program. Responsible for maintaining provider files, notes & database operations.
- Worked with claims dept on out of network denials & preauthorization department to obtain temporary authorizations for pending providers.
- Initiated & maintained Collaborative Agreements for supervising prescriptive authority, referrals & chart reviews.
Pre Authorization Specialist
UMC Pain & Neurosurgery
Lubbock, TX
09.2017 - 02.2018
- Employed full time as Pre Authorization Specialist for Neurosurgery & Pain Management clinic.
- Responsible for submitting pre authorizations to patient issued commercial & government insurance plans for pain management & neurosurgery procedures.
- Obtain approvals confirming rendering provider & authorization of requested procedures.
- Follow up on pending requests & expedite requests for emergency procedures.
- Notify appropriate providers, surgery centers, hospitals & facilities of pre authorization approvals & status updates.
- Frequent communication with Scheduling Coordinators at surgery centers, hospitals & facilities to schedule authorized procedures.
- Document all calls with patient insurance plans, providers, facilities & scheduling coordinators regarding pre authorizations, enter call details & scan all correspondence into database & EMR system.
Credentialing Specialist
Lubbock Spine Institute
Lubbock, TX
04.2014 - 08.2017
- Employed as full time Credentialing Specialist for private practice Neurosurgery & Pain Management clinic. Practice consisted of 5 multi specialty pain & neuro physicians, 10 Nurse Practitioner & Physician Assistant midlevel providers, 1 Chiropractor & 1 Physical Therapist.
- Prepare and submit initial group & individual enrollment applications to commercial & government payers.
- Obtained approvals for initial individual enrollments & group contracts
- Completed required revalidation/recredentialing requests to maintain network participation & renew contracts.
- Create & maintain provider CAQH profiles.
- Track and manage provider expirables & renewal timelines.
- Request provider privilege packets & applications from hospitals & facilities. Complete & submit applications & all supporting documents required to initiate privileging process.
- Assisted with submitting claims for basic office visits to Medicare & Commercial insurance companies.
- Posted patient copays, patient payments and insurance payments to patient accounts. Sent out patient invoices & statements.
- Responsible for ordering administrative employee uniforms, provider scrubs & lab coats.
Education
No Degree - Telecommunications, Journalism
South Plains College
Levelland, TXDiploma - General High School Diploma
Levelland High School
Levelland, TXSkills
- Provider credentialing
- Network enrollment expertise
- Commercial & Government Insurance Networks
- Managed Care Networks
- Facility Credentialing
- CAQH expertise
- License verifications
- Regulatory compliance
- Documentation and recordkeeping
- Database maintenance
- Effective communication
- Organizational skills
Certification
Currently enrolled in first session 2027 Certified Professional Credentialer course. Exam will be scheduled upon completion of course.
Professional References
References Available Upon Request
Timeline
Senior Credentialing Specialist
MSI-RCM / Brookline Community Mental Health Center
10.2022 - Current
Credentialing Specialist
Lubbock Family Medicine
01.2019 - 09.2022
Credentialing Specialist
Physicians Unity/Wound Centrics
02.2018 - 09.2022
Pre Authorization Specialist
UMC Pain & Neurosurgery
09.2017 - 02.2018
Credentialing Specialist
Lubbock Spine Institute
04.2014 - 08.2017
No Degree - Telecommunications, Journalism
South Plains College
Diploma - General High School Diploma
Levelland High School