Clara N. Brock
Callahan,FL
Summary
As a seasoned Medical Services Professional with over 17 years of experience, I specialize in provider enrollment, healthcare insurance plan enrollment, and hospital medical staff credentialing across diverse healthcare settings. My role involves meticulously credentialing healthcare providers and organizations, conducting thorough research on prior Medicare backgrounds to assess Fraud Risk Level, and processing enrollment applications for various health payors. I excel in managing hospital and medical group privileges, possess comprehensive knowledge of insurance products, and demonstrate strong problem-solving abilities, organizational skills, and technological aptitude. Efficient Provider Enrollment Specialist known for high productivity and ability to complete tasks swiftly. Specialized in navigating complex healthcare systems, understanding regulatory compliance, and managing provider data with accuracy. Excel in communication, problem-solving, and time management, ensuring smooth enrollment processes and maintaining strong relationships with providers.
Overview
3
3
years of professional experience
Work History
Interim Provider Enrollment Specialist
OneOncology
Athens, GA
06.2023 - 09.2023
- In my role, I ensured the timely completion of credentialing processes by guiding providers on the required documentation.
- Communicated regularly with providers, payers, and internal teams regarding the status of their applications.
- Processed re-credentialing applications for existing providers according to contractual requirements.
- Validated primary source documents, such as licenses, diplomas, certifications, and other related credentials.
- I maintain and update CAQH online credentialing applications quarterly, and manage provider files on the OneOncology platform.
- Additionally, I track and maintain clinical licenses, monitor provider continuing education, and handle termination procedures by promptly notifying relevant parties for removal from practice within 30 days.
- Analyzed data from multiple sources, including Medicare, Medicaid, and databases.
- Coordinated review of third-party authorization forms when necessary.
- Submitted timely updates on pending enrollment applications to the management team.
Interim Senior Medical Staff Credentialing Coordinator
Christus Spohn Hospital
Corpus Christi, TX
11.2022 - 03.2023
- In my role, I collaborated with medical staff leaders to develop and implement credentialing policies and procedures.
- Reviewed applicant qualifications for completeness and accuracy before the submission of credentialing files.
- Organized and maintained all applications, verifications, and other documents related to provider credentials.
- Conducted primary source verification of licensure, education, training, and malpractice history.
- Maintained a database of current providers per regulatory requirements.
- Facilitated the appointment process by providing information on privileges requested.
- Tracked licensure expiration dates and coordinated renewal activities with providers.
- Assisted in preparing reports for departmental meetings regarding provider status changes.
- Provided support to medical staff departments during periodic peer review activities.
- Developed communication materials for new physicians regarding credentialing processes.
- Answered inquiries from providers regarding application status or required documentation.
- Coordinated background checks for all new hires as part of the credentialing process.
- Collaborated with medical staff leaders to develop and implement credentialing policies and procedures.
- Reviewed applicant qualifications for completeness and accuracy prior to submission of credentialing files.
- Prepared monthly reports summarizing provider data such as license expirations or renewals.
- Participated in Joint Commission surveys by providing requested information on physician credentials.
- Followed up with applicants to ensure timely completion of their credentialing file packages.
- Assessed potential conflicts between applicants' qualifications and position requirements.
Interim Medical Staff Coordinator
The Mount Sinai Health System
New York, NY
02.2022 - 10.2022
- In my role, I collaborated with medical staff leaders to develop and implement credentialing policies and procedures.
- Organized and maintained all applications, verifications, and other documents related to provider credentials.
- Conducted primary source verification of licensure, education, training, and malpractice history.
- Maintained a database of current providers, per regulatory requirements.
- Facilitated the appointment process by providing information on privileges requested.
- Reviewed applicant qualifications for completeness and accuracy prior to submission of credentialing files.
- Tracked licensure expiration dates and coordinated renewal activities with providers.
- Provided support to medical staff departments during periodic peer review activities.
- Ensured compliance with applicable state laws governing healthcare professional licensing.
- Coordinated background checks for all new hires as part of the credentialing process.
- Managed the storage of confidential records according to HIPAA regulations.
- Monitored changes in accreditation standards that impact the credentialing process.
- Assessed potential conflicts between applicants' qualifications and position requirements.
- Followed up with applicants to ensure timely completion of their credentialing file packages.
- Maintained informational resources, tracking, and documenting requests for updates, certification, and credentialing.
- Checked applications for missing information and organized all paperwork.
- Addressed and resolved discrepancies in provider documentation during credentialing.
- Provided guidance and support to new providers throughout the credentialing process.
- Maintained up-to-date records of credentialing statuses in database systems.
- Ensured strict confidentiality of provider information per HIPAA regulations.
Interim Payer Enrollment
LogixHealth Inc
Bedford, US
10.2021 - 01.2022
- In my role, I specialized in payer enrollment, facilitating multistate provider enrollment for clients.
- Reviewed and updated provider enrollment applications to ensure the accuracy and completeness of the information.
- Assisted providers with completing their application packages, including obtaining all necessary documents.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Performed verification checks for new provider enrollments per company policies and procedures.
- Guided providers on the enrollment process, timelines, and requirements.
- Resolved discrepancies between provider applications and available data sources.
- Created detailed reports outlining updates to provider profiles and any issues or errors encountered during processing activities.
- Followed up with insurance carriers to address and rectify denied claims.
- Kept a watchful eye on physician expiration dates, and contacted practitioners to inform them when such dates were near.
- Prepared weekly summaries detailing newly enrolled providers, pending and rejected applications.
Interim Credentialing Specialist
Prisma Health
Columbia, US
08.2021 - 10.2021
- In my capacity, I demonstrated proficiency in completing reappointments and privileging processes for both physicians and non-physician staff, meticulously running current primary source verification requirements.
- Managed expiring credentials through proactive email notifications, ensuring continuous compliance.
- Preparing applications for the MSO credentialing committee review showcased my attention to detail and strategic approach.
- Conducted closure audits to guarantee the accuracy and completeness of provider enrollment records, upholding strict standards.
- Handled credentialing and re-credentialing applications and ensured seamless file processing and compliance adherence.
- Maintained detailed records of provider data in the credentialing database system.
- Checked applications for missing information and organized all paperwork.
- Processed re-credentialing applications for existing providers according to contractual requirements.
- Conducted background checks on potential providers utilizing various resources, including state licensing boards, OIG and GSA Exclusion List, and NPDB.
- Assisting in credentialing applications for new providers, I ensured thorough compliance with guidelines.
- I ensured medical staff privileges were granted only post-successful application completion, maintaining regulatory compliance.
- Investigating and addressing adverse information from credentialing sources demonstrated my commitment to thorough due diligence.
- Additionally, serving as an Interim Credentialing Specialist for a 500-bed hospital underscored my ability to manage complex credentialing processes effectively.
Interim Credentialing/Provider Enrollment Analyst
Northwest Pathology
Bellingham, US
10.2020 - 07.2021
- In my role, I was responsible for completing all aspects of credentialing, reappointments, re-enrollments, and privileges for staff members and health professionals, ensuring compliance and quality standards were met.
- Conducted extensive multistate credentialing and payor enrollment research to facilitate the organization's nationwide expansion.
- Additionally, I managed and communicated expiring credentials via email and phone, maintaining an accurate and comprehensive credentialing database.
- As a Provider Enrollment Credentialing Specialist, I leveraged my expertise to streamline and optimize the client's provider enrollment processes.
- Collaborated with internal departments to ensure proper processing of enrollment applications.
- Developed system processes to streamline the provider enrollment process and improve efficiency.
- Conducted audits of existing providers' records to verify continued eligibility for participation in network programs.
- Maintained accurate records regarding all aspects of the enrollment process in a secure database.
- Created detailed reports outlining updates made to provider profiles as well as any issues or errors encountered during processing activities.
- Analyzed changes in rules and regulations related to provider enrollment and communicated relevant updates to team members.
- Participated in regular meetings with stakeholders to discuss progress on projects related to new enrollments.
- Responded promptly to inquiries from providers regarding their status within the network.
- Monitored daily workflow activity related to provider enrollments and identified areas for improvement.
- Prepared weekly summaries detailing newly enrolled providers, pending applications, rejected applications.
- Processed re-enrollment requests for terminated providers who wish to be reinstated into the network.
- Reconciled differences between submitted documentation and information received from providers against government databases.
- Actively participated in training sessions designed to update staff on changes related to provider enrolment regulations.
- Assessed potential risks associated with proposed new enrollments prior making final decisions.
- Evaluated incoming requests for exceptions or waivers from standard policy guidelines of provider enrolment criteria.
Interim Manage Care/ Medical Staff Specialist
Hartford Healthcare CVO
Hartford, US
04.2020 - 08.2020
- I demonstrated exceptional proficiency in efficiently processing enrollment applications for government and commercial health plan payors, ensuring strict adherence to ongoing participation requirements.
- Created and maintained files for medical staff members, including Credentialing Verification Office documents.
- Coordinated the processing of new applications to ensure timely completion of the credentialing process.
- Maintained accurate records per Joint Commission standards.
- Assisted in coordinating meetings of the Medical Executive Committee, Department Chairs, Chiefs, Quality Improvement Committees, and other committees as necessary.
- Prepared agendas, minutes, and other materials related to MEC meetings.
- Managed databases of credentialing information, such as licensure status, board certifications, and malpractice history.
- Scheduled appointments for applicants seeking medical staff privileges with appropriate departments or services for review purposes.
- Processed requests from external agencies regarding verifications of credentials of current or former physicians or allied health professionals associated with the facility.
- Ensured that all required documentation was completed accurately before submission or presentation at a meeting.
- Reviewed disciplinary actions against practitioners by outside entities, such as state licensing boards, to determine their impact on hospital privileges.
- Participated in professional organizations relevant to the field of Medical Staff Services.
Education
Bachelor of Science (B.S.) - Sociology
Florida Agricultural & Mechanical University
Tallahassee, FL, US12-2025
High School Diploma -
West Nassau High School
Callahan06.1999
Skills
- Cactus
- ECHO
- PECOS Web
- SyMed
- CAQH
- NCQA
- CMS
- Provider Enrollment Tracking System (PETS)
- Microsoft Programs
- Application Tracking System (ATS)
- MCS
- FISS
- NDB
- PSUP
- PHYCON
- Hi-Glass
- CICSI
- NPDB
- OnBase
- JENKS
- PGBA
- HIPDB
- Streamline Tracking
- Omega
- Titan
- AMA
- NSC
- ECFMG
- ABMS
- DEA
- CSR
- OIG
- NPI
- NPLS
- SAM
- GSA
- IFlow
- MSOW
- Verity Stream
- MD Staff
- EVIPS
- Allscripts
- Credential Stream Verity
- Joint Commission
- Credentialing Requirements
- Provider Enrollment
- Background Checks
- Credentialing Policies
- Reading Comprehension
- Facility Credentialing
- Community Health Center Credentialing
- Solo Practitioner Credentialing
- Insurance Credentialing Processes
- Microsoft Office
- Database Maintenance
- Credentialing Documentation
- Credentialing Audits
- Remote Conferencing and Communication
- Effective written and verbal communication
- Physician enrollment
- Special projects
- Re-credentialing request follow up
- Project management experience
- Reporting and file reviews
- Data entry proficiency
- Credentialing data coordination
- Team meeting participation
- Practitioner enrollment
- Validation of discrepancies
- Potential participant assessments
- Process improvement techniques
- Record maintenance
- Telephone and email skills
- Data entry skills
- Applicant screening
- Application verification
- Time management proficiency
References
References available upon request.
Timeline
Interim Provider Enrollment Specialist
OneOncology
06.2023 - 09.2023
Interim Senior Medical Staff Credentialing Coordinator
Christus Spohn Hospital
11.2022 - 03.2023
Interim Medical Staff Coordinator
The Mount Sinai Health System
02.2022 - 10.2022
Interim Payer Enrollment
LogixHealth Inc
10.2021 - 01.2022
Interim Credentialing Specialist
Prisma Health
08.2021 - 10.2021
Interim Credentialing/Provider Enrollment Analyst
Northwest Pathology
10.2020 - 07.2021
Interim Manage Care/ Medical Staff Specialist
Hartford Healthcare CVO
04.2020 - 08.2020
Bachelor of Science (B.S.) - Sociology
Florida Agricultural & Mechanical University
High School Diploma -
West Nassau High School
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