Brittany Fransaw
Rosharon,Texas
Summary
Credentialing professional well-versed in intricacies of credentialing procedures and administrative duties. Known for maintaining meticulous records and ensuring compliance with regulatory standards. Highly collaborative, adaptable, and results-oriented, consistently supporting team goals and adapting to changing requirements. Proficient in data management and process improvement.
Overview
19
19
years of professional experience
Work History
Credentialing Assistant
Texas Childrens Pediatric
05.2022 - Current
- Responsible for completing Initial Appointment and Re-Appointments in a timely manner.
- Prepare Credentialing Committee Meeting Agendas, Attendance and Minutes.
- Manage a high volume of primary source verifications while maintaining attention to detail and accuracy throughout the process.
- Serve as a liaison between providers and the CVO facilitating clear communication regarding requirements and expectations throughout the credentialing process.
- Reduced errors in data entry by maintaining accurate records of provider information in the credentialing database
- Ensure compliance within NCQA standards for over 550 plus providers by staying current on industry guidelines and applying them to daily tasks.
- Maintained strict confidentiality when handling sensitive information pertaining to providers credentials and personal history.
- Update departmental spreadsheets regularly to track progress on pending applications, allowing for effective workload management
- Create Full Summary Reports and distribute to leadership to provide updates on providers status, ensuring smooth transitions during onboarding.
- Conduct regular audits of provider files to ensure ongoing compliance with accreditation standards and organizational requirements.
- Receive and evaluate physician files for missing and inaccurate information.
- Obtain NPI and taxonomy numbers for providers and facilities and update existing profiles and insurance reports.
- Process documentation for physician updates such as transfers, resignations and terminations.
- Manage and lead the patient grievance process and procedures.
- Collaborate and network with various department teams within the organization such as talent acquisition, HR, risk management, central business office, family advocacy, etc.
- Proficient in Microsoft Office, EPIC Management System, ECHO, Insights and Aperture Credentialing Data Transfer System.
- Ensure Collaborative Agreements and Delineation of Privilege's are up to date and on file for all providers
- Collect Delegated Oversights for over 100 Advanced Practice Providers monthly.
Texas Childrens Health Plan
Senior Member Services Representative
05.2021 - 05.2022
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Assist members with in network benefits, referrals and authorization status.
- Ensure physician NPI and medical codes were correct for processing of claims
- Register patients utilizing EPIC and initiate RTE to confirm active coverage
- Liaison between the patient family and external sources such as Human and Health Service to determine level of coverage
- Prescription verifications via Navitus
- Discuss physician panels and assist with obtaining appointments
- Develop efficient work flows to assist with work pools and in-baskets
- Manage and trained new incoming representatives on the My Chart process
- Handled approximately 80-95 incoming calls daily
Diagnostic Scheduler II
Houston Methodist Hospital
08.2019 - 05.2021
Patient Access Coordinator
Houston Methodist Primary Care Group
07.2018 - 08.2019
Scheduling Coordinator (Part Time)
Advanced Orthopedic And Sports Medicine
08.2017 - 07.2018
PBX Operator/Dispatcher
Methodist Hospital (Willow Brook)
12.2014 - 07.2018
PBX Operator/Ambassador
Kingwood Medical Center (Kingwood)
05.2015 - 04.2016
Phone Operator/Scheduler
SJMC Physicians (Ortho)
07.2014 - 02.2015
Intake Coordinator, Scheduler
Family Psychiatry of the Woodlands
10.2012 - 07.2014
PBX Operator, Admissions, Medical Records
Cypress Creek Hospital
10.2010 - 10.2012
PBX Operator/Receptionist/ER Admissions
FOUNDATION SURGICAL HOSPITAL
05.2006 - 10.2010
Education
HS Diploma -
North Shore High School
Houston, TX05.2006
Skills
- Proficient in EPIC Systems
- ECHO
- HIS Management Expertise
- T-systems
- Proficient Microsoft Office
- Credential verification
- HCPCS
- ICD-10 and CPT codes
- HMOs, PPOs, Government payers
- Insurance Eligibility Verification
- Authorizations
- Policy adherence
- HIPAA, PHI and PII compliance
- Database maintenance
- Regulatory compliance
Timeline
Credentialing Assistant
Texas Childrens Pediatric
05.2022 - Current
Texas Childrens Health Plan
Senior Member Services Representative
05.2021 - 05.2022
Diagnostic Scheduler II
Houston Methodist Hospital
08.2019 - 05.2021
Patient Access Coordinator
Houston Methodist Primary Care Group
07.2018 - 08.2019
Scheduling Coordinator (Part Time)
Advanced Orthopedic And Sports Medicine
08.2017 - 07.2018
PBX Operator/Ambassador
Kingwood Medical Center (Kingwood)
05.2015 - 04.2016
PBX Operator/Dispatcher
Methodist Hospital (Willow Brook)
12.2014 - 07.2018
Phone Operator/Scheduler
SJMC Physicians (Ortho)
07.2014 - 02.2015
Intake Coordinator, Scheduler
Family Psychiatry of the Woodlands
10.2012 - 07.2014
PBX Operator, Admissions, Medical Records
Cypress Creek Hospital
10.2010 - 10.2012
PBX Operator/Receptionist/ER Admissions
FOUNDATION SURGICAL HOSPITAL
05.2006 - 10.2010
HS Diploma -
North Shore High School
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