Desiree Maravilla
Antioch,CA
Summary
Collaborative leader with dedication to partnering with coworkers to promote engaged, empowering work culture. Documented strengths in building and maintaining relationships with diverse range of stakeholders in dynamic, fast-paced settings.
Overview
9
9
years of professional experience
Work History
Credentialing Manager
Spring Health
08.2023 - Current
- Oversee practitioner credentialing/recredentialing, ensuring compliance with NCQA standards and performing pre-delegation and annual audits.
- Manage credentialing operations, ensuring quality and supporting organizational growth.
- Lead Credentialing Department, setting and tracking performance goals and metrics, and preparing detailed reports.
- Ensure provider credentialing aligns with State, Federal, NCQA guidelines, and health plan requirements.
- Prepare credentialing files for timely review by committees, coordinating meetings and presenting necessary documents.
- Conduct pre-delegation and annual audits to ensure compliance with credentialing agreements and regulatory standards
- Expedited the resolution of credentialing issues by liaising effectively with providers and external organizations.
- Reduced processing times for credential applications by optimizing workflow efficiency and staff allocation.
- Lead preparation efforts for NCQA accreditation, ensuring all processes and documentation meet compliance standards and organizational requirements.
- Collaborate with cross-functional teams and external partners to ensure seamless credentialing and recredentialing of providers.
- Chair credentialing committee meetings, presenting credentialing files for review and decision-making.
- Ensure timely submission of required reports and data to health plans and regulatory bodies as part of delegated oversight responsibilities.
- Conduct internal audits and quality assurance reviews to maintain high standards of accuracy and compliance in credentialing processes.
- Process, review, and approve or deny an average of 800 credentialing files per month, ensuring accuracy and compliance with regulatory and organizational standards.
Licensing and Credentialing Manager
98point6
07.2022 - 03.2023
- Manage and delegate credentialing process for all clinician types in accordance with NCQA and CMS accreditation standards, federal and state laws.
- Collaborate with others to improve and manage broader credentialing program at 98point6 (policies, audits, ensuring regulatory compliance)
- Analyze NCQA and CMS standards and developed criteria to ensure compliance; revised general aspects of credentialing and privileging process as necessary.
- Manage the delivery of weekly MGO Program Report, which summarizes accomplishments and risks for others around the company.
- Track metrics related to the efficiency of my team's work. Develop and maintain dashboard for executives to better understand the work at a glance.
- Conduct delegated credentialing committee meetings. Research regulations and informed various departments of any changes to regulatory requirements in relation to credentialing requirements.
- Participate in audits by internal and external regulators Prepare pre-delegation audits for new delegated entities and ensure that coordinators continue to perform delegated activities in accordance with agreements
- Conduct annual credentialing audits in compliance with delegated credentialing contracts. Review monthly regulatory and disciplinary action reports issued by state licensure bodies, federal agents, and the Office of Inspector General Medicaid and Medicare sanctions report.
- Review, edit and maintain company credentialing policies and procedures to ensure compliance with NCQA standards. Oversee supervision of personnel, which includes work allocation, training, promotion, enforcement of internal procedures and controls, and problem resolution.
- Evaluate performance and makes recommendations for personnel actions; motivates employees to achieve peak productivity and performance.
- License all provider types across the United States
Sr. Credentialing Manager
LifeStance Health (formally PCPA)
01.2020 - 03.2022
- Created and Staffed national credentialing department
- Managed over 120 employees
- Analyze NCQA and CMS standards and developed criteria to ensure compliance
- Created delegated credentialing P&Ps according to NCQA guidelines
- Conducted credentialing national audits to ensure compliance with delegated credentialing contracts
- Managed multiple credentialing concurrent audits
- Obtained delegated credentialing contracts with all major payors in all states (Anthem, Magellan, Optum, Cigna, Aetna, Humana, etc.), shortening credentialing turnaround times from 90-120 days to 45 days on average.
- Conducted Delegated Credentialing Committee Meetings
- Obtained NCQA accreditation for company
- Negotiated fees and contract terms with major plans. Conducted fee analysis, surveys, and productivity reviews with recommendations to senior leadership.
- Collaborated with all departmental levels on both the hospital and physician sides. Ensure operational issues are addressed and remedied through negotiation, project planning, or contract modification.
- Credential over 300 providers at a time when a new practice was acquired. Submit providers to all insurance plans within 30 business days
- Oversee the supervision of personnel, which includes work allocation, training, promotion, enforcement of internal procedures and controls, and problem resolution'
Assistant Practice Manager
Pacific Coast Psychiatric Associates
04.2017 - 01.2020
- Maintained payroll and benefits for employees in various locations.
- Developed provider productivity model and in-person/telehealth hybrid roles.
- Created KPI reports: intake fill rate, patient registrations, office capacity, patient experience, and unsigned sessions report.
- Built custom EMR with online scheduling and patient portal, working with developer and senior clinical leadership.
- Implemented fee-for-service salary model for clinicians (converting from previous salary model).
- Led staff orientation programs and trainings.
- Recruited and interviewed non clinical employees.
- Facilitated onboarding sessions for new hires including clinical providers
- Managed payroll for admin staff and clinical staff.
- Educated new hires about different benefit plans.
- Directed and controlled 401K, medical, dental and vision benefit packages.
- Oversaw accounting, budgeting, and financial reporting.
- Ordered all office supplies and kept check on inventory levels.
- Conducted routine facility inspections across the state.
- Assisted with patient complaints and grievances.
- Supervised team of 40 office personnel.
- Created and implemented organizational policies and procedures.
- Opened 22 de novo sites, increasing total office capacity by 169%, between 4/2019 and 10/2021. Spearheaded business expansion across California, including new buildouts and retrofits.
Medical Receptionist/Intake Coordinator
Pacific Coast Psychiatric Associates
02.2016 - 04.2017
- Handled incoming patient interviews,
- Supported office staff with administrative tasks.
- Organized paperwork such as charts and reports for office and patient needs.
- Documented patient medical information to assure smooth appointments and payment processing.
- Enhanced office productivity by handling high volume of callers per day.
- Managed master calendar and scheduled appointments for providers based on clinician availability.
Education
High School Diploma -
De Anza High School
06.2012
Skills
- Microsoft Word
- Data Communications
- Research and Analytical Skills
- Multitasking and Time Management
- Payroll Oversight
- Recruiting and training new employees
Timeline
Credentialing Manager
Spring Health
08.2023 - Current
Licensing and Credentialing Manager
98point6
07.2022 - 03.2023
Sr. Credentialing Manager
LifeStance Health (formally PCPA)
01.2020 - 03.2022
Assistant Practice Manager
Pacific Coast Psychiatric Associates
04.2017 - 01.2020
Medical Receptionist/Intake Coordinator
Pacific Coast Psychiatric Associates
02.2016 - 04.2017
High School Diploma -
De Anza High School
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