DANIELLE ADAMS
Cincinnati
Summary
Results-driven Lead Credentialing Specialist with 8+ years utilizing exceptional organizational and time-management skills to manage onboarding and compliance for healthcare systems. Experienced in using platforms such as QGenda and IntelliSoft to streamline credentialing processes and ensure compliance with NCQA standards. Skilled in cultivating relationships and collaborating with healthcare providers, administrators and third-party organizations to gather and verify necessary documentation.
Overview
11
11
years of professional experience
Work History
Lead Credentialing Specialist
VitalSolution
Cincinnati
07.2024 - Current
- Utilize leadership skills to manage and oversee region of over 15 hospitals nationwide
- Demonstrate effective verbal and written communication skills to build and maintain professional working relationships with Medical Staff Offices
- Act as single point of contact for multiple healthcare facilities to streamline credentialing processes
- Delegate tasks to credentialing specialists based on capacity and priority level for region
- Showcase my experience and knowledge to assist with policy and process improvements
- Collaborate with fellow Leads on special projects to enhance current processes and databases
- Streamlined payer enrollment process with multiple healthcare facilities to ensure timely application submissions and enrollments
- Create and deliver training materials to team members to ensure efficient process implementation
Credentialing Specialist
VitalSolution
Cincinnati
04.2022 - 07.2024
- Act as Region Lead and SME for over 15 hospitals nationwide
- Assign and distribute credentialing requests to team members as needed
- Facilitate hospital appointments and reappointments for physicians
- Facilitate hospital credentialing for cath lab nurses and techs
- Apply for and renew physician medical licenses (state and IMLCC)
- Apply for and renew physician DEA's and CDS'
- Run sanctions (NPDB, background check, OIG, NSOPW, SAM)
- Assist with the setup and scheduling of drug screens, vaccines and blood draws
- Set up and assign competency testing via Healthcare Staffing Hire
- Assisted with new Credentialing software setup and implementation
- Maintain credentialing database QGenda to ensure provider data remains current
- Use critical thinking to overcome obstacles regarding quick file turnaround
Credentialing & Managed Care Coordinator II
Oncology Hematology Care
Cincinnati
05.2017 - 03.2022
- Renew/maintain professional licenses and certifications
- Apply for and renew DEA certifications for physicians and APPS
- Maintain credentials database (IntelliSoft)
- Update and maintain CAQH profile for 65 providers
- Facilitate credentials applications for medical staff providers
- Facilitate credentials applications for payer credentialing, including Medicare, Medicaid and Workers Compensation
Billing Specialist II
Oncology Hematology Care
Cincinnati
02.2016 - 05.2017
- Review/correct chemotherapy charges submitted by physicians in the Epic system
- Work and clear out claim edit workqueue daily
- Meet daily productivity goal of 300 charges per day
Account Specialist Lead
Oncology Hematology Care
Cincinnati
09.2014 - 02.2016
- Track and monitor follow-up productivity of A/R staff
- Responsible for tracking the trend of denial codes in the Epic work-queues
- Delegate accounts to be worked to staff to ensure high dollar is priority
- Audit employee work to ensure quality
- Manage employee time cards using UltiPro system
- Responsible for hiring and terminations within the department
- Responsible for developing and training new hires
- Manage clearinghouses, i.e., Availity and Quadax
- Back-up for Charge Entry department
Education
Bachelors of Science - Healthcare Administration Specializing in Management
DeVry University
Online02.2017
Skills
- Credentialing processes
- Payer enrollment
- Credentialing database management
- Communication skills
- Training development
- Time management
- Task delegation
- Healthcare compliance
- Remote conferencing and communication
- Problem solving
Accomplishments
2023 Accelerator Award Winner - VitalSolution
Timeline
Lead Credentialing Specialist
VitalSolution
07.2024 - Current
Credentialing Specialist
VitalSolution
04.2022 - 07.2024
Credentialing & Managed Care Coordinator II
Oncology Hematology Care
05.2017 - 03.2022
Billing Specialist II
Oncology Hematology Care
02.2016 - 05.2017
Account Specialist Lead
Oncology Hematology Care
09.2014 - 02.2016
Bachelors of Science - Healthcare Administration Specializing in Management
DeVry University