Deirdre Carroll
Staten Island,US
Summary
To apply my experience and expertise in building relationships with current and new prospective clients and to collaborate on initiatives that achieve organizational objectives.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Director of Provider Relations & Medicare Compliance Officer
Princeton Physicians' Organization
Millstone Township, US
03.2010 - Current
- As the Director of Provider Relations for the largest Physician Organization in the state of New Jersey, I leverage my extensive experience and judgment to set and accomplish goals
- Reporting directly to the Executive Director & CEO, I navigate the ever-changing variety of health insurance companies, products, plans, procedures, regulations and laws
- Foster positive relations between physicians, their office staff, insurance carriers, and Penn Medicine Princeton Health
- Negotiate with current and new insurance carriers for fair and enriched rates and quality-based initiatives for the Princeton PO membership
- Recruit new provider groups to join the Physician Organization
- Ensure Organization is compliant with CMS for Fraud, Waste and Abuse training, Code of Conduct requirements, Federal Health Care Program for insurance contracted Medicare carriers
- Ensure Organization is compliant for Delegated Credentialing and following NCQA standards
- Develop and maintain professional relationships with the insurance companies’ account managers, credentialing personnel, etc
- Al, to ensure all new members are processed correctly and expeditiously, demographic changes are made as requested and physicians are reimbursed, as per the Princeton PO fee schedule
- Lead and direct the work of other provider relations personnel, and those working on provider relations projects
- Create and update a Physicians Manual that represents all the Princeton PO insurance companies
- Submit completed PO applications to the insurance companies as a delegated entity
Metropolitan Transit Authority (MTA) - Office of the Inspector General (OIG)
New York, US
07.2001 - 03.2010
- My responsibilities included planning, conducting and reporting on assigned projects; developing knowledge needed to lead/participate OIG audits and analyses
- Supervised, coordinated and/or participated in the efficient gathering and analysis of information
- Interacted with MTA agency employees and/or OIG Office staff to obtain or exchange information at which inquiries are made and responses recorded
- Conducted or participated in briefings to MTA agency officials, OIG senior management and others concerning audits and analyses
- Wrote detailed memorandums on all MTA agency interviews, all concerning inquiries and responses from meetings/interviews conducted with MTA or external personnel
- Analyzed information to conceptualize and identify findings
- Worked with a team and or management to build findings into report themes
- Assured the competence, sufficiency, reliability of analyses to support conclusions and recommendations
- Participated in planning the work of the audit unit to enable it to meet its strategic goals; identified issues and developed efficient and effective plans for major audits/analyses
- Apprised OIG management of progress, milestones, timeframes and results
- Observed operations at MTA agency locations throughout the MTA service area
Education
Bachelor of Arts - Psychology
College of Staten Island
Staten Island, NY04-2004
Associates - Business Management
College of Staten Island
Staten Island, NYSkills
- Relationship Building
- Compliance
- Auditing
- Negotiation
- Recruitment
- Training
- Reporting
- Analysis
- Administrative Staff Supervision
- Critical Thinking
- Organizational Skills
- Team Collaboration
- Written Communication
- Human Resources Management
- Relationship Management
- Provider relationship management
- Employee Performance Evaluations
- Decision-Making
Certification
- Future Healthcare Payments Models - Certificate - Northeastern Payment Models
Timeline
Director of Provider Relations & Medicare Compliance Officer
Princeton Physicians' Organization
03.2010 - Current
Metropolitan Transit Authority (MTA) - Office of the Inspector General (OIG)
07.2001 - 03.2010
Bachelor of Arts - Psychology
College of Staten Island
Associates - Business Management
College of Staten Island
Similar Profiles
Deirdre CarrollDeirdre Carroll
Director, Provider Relations Department at PRINCETON PHYSICIANS' ORGANIZATIONDirector, Provider Relations Department at PRINCETON PHYSICIANS' ORGANIZATION
MYCHAEL (Kell) GREGORYMYCHAEL (Kell) GREGORY
SURGICAL TECHNICIAN at PULSE PHYSICIANS’ HEALTHCARE ORGANIZATIONSURGICAL TECHNICIAN at PULSE PHYSICIANS’ HEALTHCARE ORGANIZATION
KIM BELLKIM BELL
Nurse Case Manager at Reliance Physicians OrganizationNurse Case Manager at Reliance Physicians Organization
Rohan GreyRohan Grey
Network Administrator at ManTechNetwork Administrator at ManTech
DEVON MALAVEDEVON MALAVE
Host at BesoHost at Beso