Brandi Flowers
2501 Mountain Ash Circle Glen Allen,VA
Summary
Credentialing Manager with 22+ years of healthcare experience overseeing provider enrollment, credentialing, recredentialing, onboarding, and compliance. Expertise includes maintaining accreditation standards, managing payer relationships, auditing provider files, and ensuring compliance with CMS, NCQA, Joint Commission, and state regulations. Proven success in streamlining workflows, improving turnaround times, and leading cross-functional teams while maintaining accuracy and confidentiality. Strong background in healthcare administration systems, contract management, and resolving complex credentialing issues to support operational efficiency and quality.
Overview
20
20
years of professional experience
Work History
Credentialing Manager
Healthy Young Minds
Edwards, Colorado
04.2024 - Current
- Oversaw comprehensive provider enrollment and onboarding processes across diverse states and payer networks.
- Managed enrollment processes by overseeing application submissions, tracking progress, and facilitating approval workflows.
- Managed approximately 30 incoming emails from internal and external customers.
- Facilitated payer relationship management as the primary point of contact for issue resolution and escalations.
- Facilitated collaboration between clinical operations and HR teams to streamline provider onboarding processes.
- Implemented and managed tracking systems to monitor enrollment status, aiming to reduce processing delays.
- Coordinated contracts and engaged providers to optimize participation in payer networks.
- Analyzed workflow gaps and executed process enhancements to optimize enrollment timelines.
Credentialing Manager
Dominion Care
Richmond, Virginia
05.2022 - 10.2023
- Supervised provider enrollment and recredentialing for over 26 providers with the workflows, maintaining high standards for submission accuracy and timeliness.
- Supported onboarding timelines by coordinating documentation and payer requirements.
- Partnered with internal departments to align credentialing and enrollment with provider start dates.
- Assisted in resolving payer-related issues and reducing application delays.
- Maintained compliance with all regulatory and payer standards.
Manager of Accounts
Physician Practice Specialist
Jacksonville, Florida
04.2021 - 05.2022
- Streamlined provider enrollment and onboarding to enhance client account management for over 150 providers.
- Oversaw completion of all payer enrollment requirements before provider start dates.
- Streamlined tracking systems to enhance visibility into enrollment progress.
- Collaborated with providers and internal teams to streamline onboarding processes.
Project Manager
Cenevia
Richmond, Virginia
01.2021 - 04.2021
- Directed project execution by collaborating with internal teams and external vendors to ensure alignment.
- Championed timely project completion and budget compliance through strategic planning initiatives.
- Engaged with stakeholders to define and refine project objectives and scopes.
- Oversaw resource allocation to optimize project performance.
- Crafted comprehensive project plans to facilitate continuous progress assessment.
- Adapted to project parameter changes with accuracy and efficiency.
- Assessed project success through adherence to proven management practices.
- Communicated project developments and escalated concerns to management as required.
Credentialing Manager
Cenevia
Richmond, Virginia
12.2011 - 01.2021
- Coordinated comprehensive credentialing and onboarding processes for large provider groups with over 600 providers, ensuring compliance and streamlined integration.
- Managed payer enrollment processes to streamline application submission and enhance follow-up efficiency.
- Performed thorough primary source verifications to ensure adherence to regulatory requirements.
- Coordinated with providers to provide updates on enrollment status and outline next steps for process completion.
- Analyzed and optimized onboarding processes to reduce time-to-productivity for new employees.
Credentialing Specialist
WellPoint
Richmond, Virginia
10.2006 - 08.2011
- Organized and prepared requested files and documents for evaluation by clinical service chief and credentials committee to support thorough assessment processes.
- Conducted third-party verifications of submitted materials according to department and medical staff policies. Verified accuracy of modifications made to the database.
- Ensured accurate and secure storage of practitioner data files to support operational efficiency.
- Assessed provider applications for thoroughness to facilitate onboarding processes.
- Conducted outreach to medical schools to ensure accurate verification of graduation dates for prospective candidates.
- Conducted outreach to state boards for verification of current license status.
- Compiled and structured necessary documentation to facilitate credentialing committee meetings.
- Coordinated communication with providers to address and resolve issues related to expired documents.
- Reviewed and revised provider profiles in credentialing database, enhancing data reliability and accessibility.
- Produced comprehensive reports to ensure timely awareness of credential expirations.
- Coordinated the collection and submission of required documentation in response to auditor inquiries.
- Managed the enrollment application process for healthcare providers, streamlining documentation for insurance panel integration.
- Monitored and updated status of pending applications to ensure timely processing.
Education
Bachelor of Science - Business Management
University of Arizona
Phoenix, AZ11-2010
Associate of Science - Healthcare Administration
University of Arizona
Phoenix, AZ05-2009
Skills
- Experienced with Google Suite applications
- Experienced with Microsoft Office applications
- Provider onboarding
- Data analysis proficiency
- Verification of credentials
- Permit tracking and management
- Meticulous attention to detail
- Skilled at prioritizing tasks simultaneously
Languages
English
Full Professional
Timeline
Credentialing Manager
Healthy Young Minds
04.2024 - Current
Credentialing Manager
Dominion Care
05.2022 - 10.2023
Manager of Accounts
Physician Practice Specialist
04.2021 - 05.2022
Project Manager
Cenevia
01.2021 - 04.2021
Credentialing Manager
Cenevia
12.2011 - 01.2021
Credentialing Specialist
WellPoint
10.2006 - 08.2011
Bachelor of Science - Business Management
University of Arizona
Associate of Science - Healthcare Administration
University of Arizona