DeAnna Hemphill

• Provides leadership and direction to Credentialing Specialists
• Ensures credentialing and privileging compliance with applicable bylaws, CMS, NCQA, and Joint Commission standards.
• Facilitates monthly credential committees
• Develop internal credentialing processes
• Create & revise credentialing policies
• Audit Michigan Disciplinary reports, OIG reports, and other reports as required and initiate theformal complaint procedure when applicable.• Assist with annual delegated credentialing audits and National Committee on Quality Assurance(NCQA) audits.
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Responsible for monitoring and managing credentialing/re-credentialing requirements and to ensure the collection of all required renewal certifications are on file within the required time

• Direct collaboration with ICO for audit purposes
• Developed comprehensive training materials for new hires, promoting consistency in credentialing processes across the organization.
• Enhanced compliance with industry standards by conducting thorough audits of credential files.
• Established strong relationships with external agencies, streamlining communication regarding provider credentials and facility statuses.
• Demonstrated excellent problem-solving skills in identifying and resolving discrepancies in provider documentation, ensuring compliance with regulatory requirements.
• Implemented a secure document storage system that improved confidentiality while ensuring easy access during audits.
• Managed the onboarding process for new providers, ensuring timely completion of all required documentation.
• Facilitated smooth communication between departments, fostering collaboration in support of credential management objectives.
• Led team meetings to discuss progress toward goals, troubleshoot issues, and share best practices among colleagues.
• Maintained up-to-date knowledge of industry regulations, ensuring ongoing adherence to best practices in provider credentialing.
• Mentored junior team members on best practices in provider relations and customer service.
• Expedited the resolution of credentialing issues by liaising effectively with providers and external organizations.

• Complies and maintains current and accurate data for all healthcare providers.
• Planned and developed policies, annual goals/objectives, and the financial program set by the Board of Directors
• Efficient in using various HRIS Systems such as; UKG Pro, UKG Ready, Workday, Paycor, and Kronos.
• Completes provider credentialing and re-credentialing applications, primary source verifications.
• Initiated process to automate several onboarding tasks, streamlining processes.
• Experience servicing managed care contracts and reimbursement rates to provides.
• Provider Enrollment with various health plans. Receive and respond to any provider related issues. Also, experience with Medicare and Medicaid enrollment.
• Conducts and complete all credentialing audits.
• Data Entry, Medical Records, Health Care, Insurance Claims Processing and Proof Reading/Editing of Documents
• Provide support to managers on how to complete their duties in line with the HR policy.
• Creating employee engagement plans, getting necessary budget approval, and initiating activities
• Manages user access to CMS.
• Resolve medical claim issues, accurately processing data relating to insurance and demographic information following unit specific policies while maintaining current knowledge of payor insurance requirements.
• Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance.
• Have the ability to manage multiple projects in a fast pace environment
• Ongoing monitoring of credentialed network for accuracy or any change in status to include regular internal practitioner record audits.
• Creating onboarding plans and educating newly hired employees on policies and procedures
• Responsible for monitoring and managing credentialing/re-credentialing requirements and to ensure the collection of all required renewal certifications are on file within the required time frame.
• Analyzing data in Excel to format and provide actionable breakdowns for leaders.
• Experience with multi-line phone system.
• Provide consistent and timely follow-up on all outstanding credentialing/re-credentialing files. Supports analytic and reporting needs related to key account management.
• Prepare and scan credentialing/re-credentialing files and other credentialing documentation into scanning software.
• Prepare credential committee grids and any adverse action documentation.
• Attend monthly credentials committee meetings as requested. Answer credentialing telephone line and provide support to physicians, physician office staff, health plan contacts and company departments as necessary. Provider network engagement
• Adhere to credentialing policies and procedures and medical staff policies.

• Responsible for assuring patient safety and ensuring the quality of the provider network through the rigorous credentialing and recredentialing process, conducted in accordance with regulatory agencies, accrediting bodies, Health Plan Bylaws and Health Plan policies and procedure for the initial, renewal and augmentation of applicants requesting membership into the Health Plans network. Obtain primary source verification (verifying all elements of application directly with the source, such as medical school, residency program, previous hospitals, licensing board, and any other required source).
• Maintain credentialing database.
• Conduct ongoing monitoring of sanctions or disciplinary actions such as license and Medicare sanctions.
• Customer Service, overnight

• Delegated and Traditional credentialing. Verifying accuracy of credentialing applications. Enrolling all doctors in Medicare, Medicaid, and various health plans.
• Trainings all new staff apart of the credentialing team, to ensure they able to work efficiently by themselves.
• Knowledge of practitioner credentialing and primary source verification of medical/dental licensure, Dental Office Experience.
• Help resolve claim issues, and perform all duties assigned.

• Tradition credentialing. Assist in daily data entry to ensure accurate physician data base. Primary source verify.
• Comply with all NCQA guidelines. Meet processing time thresholds consistently with minimum error.
• Knowledge of NCQA & JCAHO standards, NPDB guidelines and general licensing regulations.
• Assess potential physician/practitioner problem areas for credentialing risks; gather and assess information from governmental agencies, e.g., National Practitioner Data Bank; maintain skills for effective retrieval of information.

• Completed 16 credit hours in the field. Completed various task such as credentialing, Human Resources, accounting, admissions, marketing, medical staff office, primary source verification. Healthcare terminology experience.

• Assisted patients with various mental and physical health disorders with acts of daily living by administering medications.
• Design and facilitate daily activities to optimize youth activities.
• Assist with guidance and behavior modifications of at-risk youth.
• Crisis Intervention.
• CMS Training.
• Maintaining EMR's.