DuShawn G Barnes
Rockville,MD
Summary
- Offering:
- 25 years of credentialing experience working in healthcare environments.
- Expertise in coordinating provider’s Initial applications and the re-credentialing process.
- Solid knowledge of NCQA and JCAHO credentialing standards.
- Proven ability to work independently and efficiently with superior results.
Overview
25
25
years of professional experience
Work History
Credentialing Specialist
HOLY CROSS HOSPITAL
SILVER SPRING, MD
03.2020 - Current
- Coordinates and supports the Medical Staff’s credentialing process, including supporting Trinity Health CPI with the processing of new applications, requests for change of status, end of Provisional reviews and proctoring of new medical staff members
- Assists in development, planning and operational management of the credentialing/privileges delineation program to ensure the program’s integrity
- Provide general administrative support to the organized Medical Staff
- Coordinates and facilitates formal and informal credentialing peer review/recommendation processes per established policies and procedures
- Initiates information collection, verification and documentation process for initial files per established policies and procedures
- Protects the highly confidential nature of Medical Staff proceedings/actions, and sensitive information including credentialing information, peer review, quality assurance and economic consequences of physicians behavior
Credentialing Coordinator
KAISER PERMANENTE
ROCKVILLE, MD
01.2012 - 02.2020
- Assured that only credentialed practitioners and providers render care to Kaiser
- Permanente members and that all practitioners, providers and delegates meet Kaiser
- Permanente’s regulatory and accreditation standards
- Initiated and follows through on all aspects of credentialing including the initial and re-credentialing process for all practitioners employed and/or contracted with Kaiser
- Permanente of the Mid-Atlantic States
- In addition, initiates and follows through on all aspects of the privileging and re-privileging of Mid-Atlantic Permanente Medical Group physicians with Ambulatory Surgery Center (ASC) privileges
- Initiated and conducts primary source verification of practitioner’s background, education/training and malpractice history through the use of on-line systems, written correspondence, telephone inquiries and printed reference guides, rosters and reports
- Identified and evaluates potential red flags and works in collaboration with department
Credentialing Analyst
CHILDREN’S NATIONAL MEDICAL CENTER
WASHINGTON, DC
06.2005 - 01.2012
- Ensures the integrity of the credentialing functions are maintained, including timeliness of all established processes
- Conducts credentialing and re-credentialing activities for all providers in the CNMC networks
- Responsible for provider enrollment of physician in the Medicaid and Medicare Networks
- Responsible for ongoing data maintenance and accuracy of the credentialing database “ECHO”
- Establishes, maintains and reports statistical data regarding credentialing activities
- Coordinator for Managed Care Audits
Credentialing Coordinator
DC CHARTERED HEALTH PLAN, INC
WASHINGTON, DC
06.1999 - 06.2005
- Ensured the integrity of the credentialing functions are maintained, including timeliness of all established processes
- Maintained credentialing files for all CHP providers, including the collection and verification of all provider information
- Conducted credentialing and re-credentialing activities for all providers in the CHP network
- Distributed all re-credentialing applications and relevant materials to providers Coordinates the reappointment of providers on or before their two-year anniversary of Plan participation
- Managed requests for information from recognized source verification organizations
- If adverse reports are returned on providers, researched the allegations and present findings to the Credentialing Committee for their decision regarding the acceptance of the provider to the Plan
- Established and maintained statistical data reporting regarding all credentialing functions as it relates to contracting
- Received all completed applications and supporting documentation for credentialing and re-credentialing activities
- Entered provider information in the credentialing database
- Communicated provider’s credentialing status in writing to network providers
- Communicated provider’s credentialing status and coordinated provider profiling Reviewed and verified provider information in the provider database
- Scheduled credentialing meetings and arranged the logistics of the meeting
- Recorded and prepared minutes and distributed to all the relevant parties
- Assisted with review and audit of credentialing, where credentialing was delegated
Manager/Director
- And/or Physician Managers to determine next steps
- Performed List Validation and Reporting (LVAR) queries per the National Compliance
- Office and Regional Compliance department and in compliance with federal and state regulations
- Performed analysis of report data and state board sanctions information in compliance with regulatory on-going monitoring requirements
- Responsible for preparation of materials and files for presentation and review by the Mid-
- Atlantic States Credentialing & Privileging (MASCAP) committee
- Ensured compliance with NCQA Standards and other regulatory agencies
- Assisted in the development of policies and procedures to support the credentialing process
- Collaborated with inter-departmental peers, including Quality Management, Provider
- Relations, and Provider Contracting & Data Management
Timeline
Credentialing Specialist
HOLY CROSS HOSPITAL
03.2020 - Current
Credentialing Coordinator
KAISER PERMANENTE
01.2012 - 02.2020
Credentialing Analyst
CHILDREN’S NATIONAL MEDICAL CENTER
06.2005 - 01.2012
Credentialing Coordinator
DC CHARTERED HEALTH PLAN, INC
06.1999 - 06.2005
Manager/Director
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