CARMAN L. ANGE
Olathe,KS
Summary
Resourceful Specialist offering expertise in problem-solving, data analysis and customer service. Adept at quickly learning new technologies and processes for driving success. Proven track record of successfully managing multiple projects and developing innovative solutions.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Senior Clinical Operations Specialist - Medical Management
GEHA, Inc.
10.2014 - 12.2023
- Evaluates information to determine medical necessity & appropriateness of the care in its relation to the diagnosis and the plans contractual provisions for authorizations utilizing plan brochure, corporate policies, and InterQual.
- Analyze/investigate/present cases that require outside consultant and/or Medical Director review.
- Perform reviews on escalated/complicated cases utilizing thorough investigation and resolution.
- Give guidance & provide resources that would assist the team to better utilize time to meet deadlines.
- Develop and generate reports documenting cost-utilization savings, referrals, and monthly production for supervisor.
- Development of resources for team processes
- Subject Matter Expert (SME) for team processes/policies, and cross-train to assist on other types of work.
- Resource for all team members and other teams
- Cross trained with other departments and assist as needed.
- Collaborate with leadership team in creating audit tool/form for DME/dental and pulling reports.
- Coordinate special projects requested by leadership including documentation, research, and meeting deadlines.
- Train/educate staff members on system, policies/procedures, and criteria.
- Utilize resources to perform each episode appropriately to meet departmental guidelines and claim status determination.
- Proficient in organization, scheduling, and general office duties; maintain organized work environment to meet department goals and turnaround time.
- Generated reports detailing findings and recommendations.
- Developed effective improvement plans in alignment with goals and specifications.
- Followed all company policies and procedures to deliver quality work.
- Enhanced team productivity by streamlining processes and implementing time-saving strategies.
- Listened and responded to customer requests and forwarded necessary information to superiors.
- Devised and implemented processes and procedures to streamline operations.
- Optimized customer experience by delivering superior services and effectively troubleshooting issues.
- Skilled at working independently and collaboratively in a team environment.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Paid attention to detail while completing assignments.
Credentialing Coordinator
GEHA, Inc.
10.2011 - 10.2014
- Credentialing/Re-credentialing of all practitioners
- Maintain numerous practitioner data repositories, e.g., education, experience, and licensure.
- Critically analyze data to create informed recommendations for credentialing/re-credentialing proceedings.
- Develop, establish, and manage compliance of Federal accreditation standards/regulations, and policies that govern activities of networking providers.
- Establishing system to facilitate meetings and communications between practitioners, both within and outside their specialties as well as with administration
- Contract management of delegated entities including review/approval with contractor/administration
- Conduct delegated entity audits for compliance of accreditation standards, & GEHA policies
- Train/educate staff members on system, and policies/procedures
- Reconciled monthly invoices.
- Upheld strict confidentiality standards, safeguarding sensitive provider information from unauthorized access or disclosure.
- Prepared records for site visits and file audits.
Credentialing Coordinator
Menorah Medical Center
08.2009 - 10.2011
- -Credentialing/Re-credentialing of all practitioners
- Analyze, and manages data verification, and maintains primary source verifications.
- Conduct/participate in/maintain credentialing and privileging, current clinical competency evaluations, and peer review.
- Critically analyze data to create informed recommendations for credentialing/re-credentialing and privileging proceedings.
- Participates in The Joint Commission accreditation surveys.
- Communication, improvements, and education of practitioners regarding findings in satisfaction surveys, performance results, and other quality metrics
- Manage compliance with State/Federal rules/regulations, policies/procedures, and accreditation standards that govern activities of medical staff.
- Facilitate medical staff functions, maintain physician on-call schedule, and physician roster.
- Manage department operations, reconcile monthly invoices/medical staff checking account.
Credentialing Coordinator
Truman Medical Center
02.2009 - 08.2009
- -Credentialing/Re-credentialing of all practitioners
- Analyze, and manages data verification, and maintains primary source verifications.
- Manage compliance with Accreditation standards and regulatory standards.
- Participates in NCQA, & The Joint Commission accreditation surveys.
Medical Staff Office Manager
St. Francis Health Center
09.2006 - 02.2009
- -Credentialing/Re-credentialing of all practitioners
- Analyze, and manages data verification, and maintains primary source verifications.
- Conducts, participates in, and maintains credentialing and privileging, current clinical competency evaluations, and peer review.
- Critically analyze data to create informed recommendations for credentialing/re-credentialing and privileging proceedings.
- Participates in The Joint Commission accreditation surveys.
- Communication/improvements, and education of practitioners regarding findings in satisfaction surveys, performance results, and other quality metrics
- Manage compliance with State/Federal applicable statutes, accreditation standards, regulatory requirements, and guidelines necessary to perform job duties in accordance with requirements of corporate compliance plan, code of conduct, and policies that govern activities of medical staff.
- Manage department operations, reconcile monthly invoices/medical staff checking account, 4 FTE's, department budget, performance reviews/promotions, personnel/corrective action plans/terminations, and attendance records.
- Facilitate medical staff functions, maintain physician on-call schedule, and physician roster.
- Maintain numerous practitioner data repositories, e.g., education, experience, and licensure.
- Set-up, train/educate staff on CACTUS credentialing software system.
Education
Managed Healthcare -
Fort Scott Community College
Fort Scott, KS03.1995
Computer & Information Systems -
Pittsburg Office Management Center
Pittsburg, KS05.1990
High School -
Girard High School
Girard, KS05.1986
Skills
- Proficient in organization, scheduling, and general office responsibilities
- Ability to interact with diverse populations
- Team Player
- Proficient in Facets, Macess, Conifer, InterQual, MS Office, MS Teams, Word, Excel, Outlook, Workday, and 10-Key
- Excellent customer service, verbal, and written communication skills
- Strong passion for working with people
Accomplishments
- Documented and resolved customer complaint which led to positive outcome.
Certification
Certified Provider Credentialing Specialist (CPCS), National Association of Medical Staff Services (NAMSS), 09/01/05
Awards
- Nominated twice for the LOVE award
- Received twenty-six-star awards for "care for our members and each other"
- Received forty-one-star awards for "work as one team"
- Received two awards for excellent customer service
- Received award from medical staff for outstanding job performance
- Received employee of the month
Affiliations
- National Association of Medical Staff Services (NAMSS)
Timeline
Senior Clinical Operations Specialist - Medical Management
GEHA, Inc.
10.2014 - 12.2023
Credentialing Coordinator
GEHA, Inc.
10.2011 - 10.2014
Credentialing Coordinator
Menorah Medical Center
08.2009 - 10.2011
Credentialing Coordinator
Truman Medical Center
02.2009 - 08.2009
Medical Staff Office Manager
St. Francis Health Center
09.2006 - 02.2009
Managed Healthcare -
Fort Scott Community College
Computer & Information Systems -
Pittsburg Office Management Center
High School -
Girard High School
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