Dana Johnson
Las Vegas,NV
Summary
Accomplished and detail-oriented Credentialing Manager with 16 years of experience in healthcare and pharmacy industries. Proven expertise in managing complex external accounts and streamlining credentialing processes to ensure compliance with federal and state regulations. Skilled in leading teams to achieve operational efficiency, training and mentoring staff, and developing action plans to drive success. Exceptional problem-solving, communication, and leadership skills with a strong focus on client satisfaction and continuous process improvement. Utilized analytical skills to diagnose critical business issues, resulting in the development and implementation of innovative solutions that drove business growth.
Overview
18
18
years of professional experience
Work History
Manager, Pharmacy Credentialing
OptumRx
01.2023 - Current
- Managed day-to-day operational functions for credentialing processes, ensuring high-quality service delivery and client satisfaction
- Analyzed the root cause of credentialing issues, developed and implemented appropriate action plans, and ensured compliance with URAC, federal, and state requirements
- Facilitated weekly meetings using Microsoft Teams and Outlook to address and resolve escalated emails and phone calls, ensuring timely processing of pharmacy credentialing and re-credentialing
- Led and mentored a stakeholders, creating and updating training materials, and developing procedures to enhance operational efficiency
- Prepared files for internal and external audits, reported metrics to senior leadership, and participated in credentialing committee meetings
- Acted as the primary point of contact for escalated concerns, ensuring resolution and maintaining client satisfaction
- Facilitated and executed work plans to meet deliverables to ensure tasks are moved to completion efficiently
- Facilitated meeting with stakeholders to discuss projects, metrics, development, process changes and deliverables
- Led projects and initiatives which led to the development and execution of new credentialing process
- Analyzed data and reporting within different UHG Systems
- Process mapping through Vizio
- Improved credentialing processes to increase productivity
- Led a cross functional team in the mapping and optimization of reducing processing errors
- Analyzed data and reporting within different UHG Systems and reported findings to leadership
Supervisor, Pharmacy Credentialing
OptumRx
02.2020 - 12.2022
- Conducted root cause analysis of credentialing issues, developed action plans, and managed the team to ensure compliance and timely processing of pharmacy credentialing
- Trained new hires and mentored the team, creating, maintaining, and editing training documents to ensure operational quality
- Assisted in developing procedures to improve efficiency, ensuring adherence to URAC, federal, and state requirements
- Facilitated and executed work plans to meet deliverables to ensure tasks are moved to completion efficiently
- Managed day-to-day operational functions for credentialing processes, ensuring high-quality service delivery and client satisfaction
- Led projects and initiatives which led to the development and execution of new credentialing process
- Analyzed data and reporting within different UHG Systems and reported findings to leadership
- Led a cross functional team in the mapping and optimization of reducing processing errors
Senior Credentialing Specialist
OptumRx
05.2018 - 02.2020
- Managed credentialing and re-credentialing processes, maintaining pharmacy licenses through primary source verification
- Updated internal tracking databases, acted as a liaison between departments, and assisted with training employees
- Ensured files were audit-ready, contributing to successful compliance audits
- Led projects and initiatives which led to the development and execution of new credentialing process
- Facilitated meetings with clients to ensure the credentialing experience was completed
Program Network Specialist
OptumRx
12.2016 - 06.2018
- Processed referrals for cease and desist and terminations, maintained reporting spreadsheets, and coordinated committee review meetings
- Communicated with legal counsel and other departments, resolving pharmacy issues regarding terminations
- Facilitate NPEC meetings for review and decision by voting members
- Communicated with pharmacies, authorized agencies regarding network termination statuses
Lead Contracting Specialist
Smile Brands Inc.
03.2013 - 05.2015
- Maintained open communication with plan representatives and dental offices, ensuring compliance with credentialing and contracting processes
- Trained new and existing employees, and led audits for delegated contract agreements
- Liaison between department and CVO (Credentials Verification Organization)
- Enrollment Providers with Payors (State Plans, Health plans)
Quality Management Credentialing Coordinator
Western Dental Services Inc.
12.2006 - 03.2013
- Created initial files for providers, audited licenses and credentials
- Maintained provider’s license and credentials databases, and assisted with quarterly reports for providers in CA and AZ
- Facilitated Credentialing Committee meetings and presented files to discuss provider backgrounds with leadership
- Coordinated CE courses for 100+ providers in several states
- Assisted with development of web-based internal system
- Trained department on how to use internal system
- Process mapping through Vizio
Education
Associate of Science - Criminal Justice
University of Phoneix
Online08-2013
Skills
- Customer service
- Team leadership
- Time management
- Decision-making
- Complex Problem-solving
- Goal setting
- Documentation and reporting
- Relationship building
- Project management
- Project planning
- Performance management
- Policy implementation
- Conflict resolution
- Workforce management
- Product management
- Policy and procedure development
- Data analysis
- Regulatory compliance
- Cross-functional team management
- Teamwork and collaboration
- Effective communication
- Problem resolution
- Adaptability and flexibility
- Attention to detail
- Multitasking
- Problem-solving
- Excellent communication
- Organizational skills
- Work Planning and Prioritization
- Advanced Computer skills
Timeline
Manager, Pharmacy Credentialing
OptumRx
01.2023 - Current
Supervisor, Pharmacy Credentialing
OptumRx
02.2020 - 12.2022
Senior Credentialing Specialist
OptumRx
05.2018 - 02.2020
Program Network Specialist
OptumRx
12.2016 - 06.2018
Lead Contracting Specialist
Smile Brands Inc.
03.2013 - 05.2015
Quality Management Credentialing Coordinator
Western Dental Services Inc.
12.2006 - 03.2013
Associate of Science - Criminal Justice
University of Phoneix
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