Colleen Gruppe
Williston Park,NY
Overview
23
23
years of professional experience
Work History
Credentialing Specialist
WellLife Network Inc.
11.2024 - 06.2025
- Compile and maintain current and accurate data for all providers
- Create / Update NPI Numbers and information for Providers
- Update information/ Billing Codes for Providers in Billing System myAvatar NX
- Complete Medicaid and Medicare Applications
- Track all provider enrollment and participation with Medicaid and Medicare
- Perform other duties as assigned
Credentialing Specialist
Sight Growth Partners
02.2022 - 11.2024
- Compile and maintain current and accurate data for all providers
- Complete provider and facility enrollment and re-credentialing applications for all state Medicaid insurance plans
- Ensure the timelines for provider enrollment to insurance payers
- Track all provider enrollment and participation with effective dates, ID numbers and billing status
- Research and resolve all provider enrollment issues
- Audit commercial and Medicaid plan directories for current and accurate provider information
- Maintain confidentiality of provider data
- Provide back-up coverage for Coordinator/Specialist
- Perform other duties as assigned
- Enhanced credentialing processes by streamlining documentation and verification procedures.
- Addressed and resolved discrepancies in provider documentation, maintaining high level of data integrity.
Sr. Credentialing Specialist
Symplr
06.2020 - 02.2022
- Processed prime source verifications for Delegated Credentialing and re-Credentialing applications for multi-state providers.
Credential Manager
PM Medical Billing Corp
03.2016 - 02.2020
- Coordinates, contracting and credentialing applications with insurance companies for 250 providers nationwide
- Enroll and re-certify physicians with Medicare and Medicaid
- Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow-up
- Update and load documents to CAQH.
- Responds to inquiries from providers, interfaces with internal and external Staff/Providers on day-to-day credentialing and privileging issues as they arise
- Monitors the reappointment and expiable process for providers.
- Performs miscellaneous job-related duties as assigned
Credentialing Coordinator
HealthCare Partners, IPA
02.2013 - 02.2016
- Coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
- Conducts thorough background investigation, research and primary source verification of all components of the application file.
- Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow-up.
- Prepares credentials file for completion and presentation to Medical Staff Committee, ensuring file completion within time periods specified.
- Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
- Responds to inquiries from providers, interfaces with internal and external Staff/Providers on day-to-day credentialing and privileging issues as they arise.
- Assists with managed care delegated credentialing audits; conducts internal file audits.
- Utilizes the Morrisey credentialing database, optimizing efficiency, and performs query, report and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act.
- Monitors the initial, reappointment and expirable process for providers, ensuring compliance with regulatory bodies (NCQA, federal and state), as well as policies and procedures, and delegated contracts.
- Performs miscellaneous job-related duties as assigned
Receptionist/Administrative Assistant
Healthcare Partners
12.2010 - 02.2013
- Managed high-volume switchboard, promptly directing 75-100 calls daily to appropriate departments.
- Delivered knowledge and information to callers as required.
- Coordinated with Office Manager to guarantee consistent reception desk staffing.
- Offered clerical and office support to Human Resources Manager upon request.
- Developed Excel spreadsheets for employee communication.
- Updated and maintained employee telephone extension records for over 300 staff members.
- Managed badge collection and staff greetings for security.
Receptionist/Administrative Assistant
Hazelton Law Firm
01.2007 - 12.2010
- Answered incoming calls and routed to proper department or person.
- Responsible for taking detailed messages and communication with office staff
- Created letters and photocopied sensitive documentation.
- Maintained a current and accurate filing system
- Responsible for scheduling meetings and other activities of the organization.
- Assisted on various office projects and was key player involved with completion of projects.
Administrative Assistant /Receptionist to President
Allied North America
08.2005 - 10.2006
- Received calls and routed to the proper party in a timely fashion
- Maintained and administered the daily Outlook contact for several executives.
- Solely Responsible for travel arrangements, including scheduling car service, providing typed itinerary report and boarding pass
- Administer expense reimbursement process
- Prepared meeting documentation by collated correspondence
Clerical Assistant/ Receptionist
Vytra Health Plans
09.2002 - 04.2004
- Created word documents that pertain to authorization/denial letters for patients
- Filed authorization letters and other documents into patient's file
- Faxed a majority of lists and letters to doctors' offices/ patients and other insurance companies
- Answered phones and direct call to proper party
Education
Diploma - Business
Dominican Commercial
Jamaica, NY05.1995
Skills
- HIPAA
- NCQA standard
- Google Suite
- Analysis skills
- Organizational skills
- Time management
- Managed Care
- Data entry
- Microsoft Outlook
- Medicare
- Project management
- HIPAA compliance
- Provider enrollment
- Data management
- Credentialing oversight
- Application coordination
- Document review
- Application management
- Credentialing documentation
- Credential verification
- License verifications
- Solo practitioner credentialing
- Facility credentialing
- Microsoft office
- Decision-making
- Training and mentoring
- Contract negotiation
- Teamwork
Timeline
Credentialing Specialist
WellLife Network Inc.
11.2024 - 06.2025
Credentialing Specialist
Sight Growth Partners
02.2022 - 11.2024
Sr. Credentialing Specialist
Symplr
06.2020 - 02.2022
Credential Manager
PM Medical Billing Corp
03.2016 - 02.2020
Credentialing Coordinator
HealthCare Partners, IPA
02.2013 - 02.2016
Receptionist/Administrative Assistant
Healthcare Partners
12.2010 - 02.2013
Receptionist/Administrative Assistant
Hazelton Law Firm
01.2007 - 12.2010
Administrative Assistant /Receptionist to President
Allied North America
08.2005 - 10.2006
Clerical Assistant/ Receptionist
Vytra Health Plans
09.2002 - 04.2004
Diploma - Business
Dominican Commercial
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