Gayle Washington
Aurora,CO
Summary
Strategic, results-driven healthcare credentialing expert with over 15 years of progressive experience leading high-volume verification, provider enrollment, and compliance operations across multi-state PACE programs, medical groups, and managed care organizations. Recognized for transforming credentialing processes, ensuring accreditation compliance (NCQA, URAC, CMS, AAAHC), and building high-performing teams to support growth and audit readiness. Excels at aligning healthcare organizations with evolving state, federal, and payer requirements while maintaining exceptional service to providers and internal stakeholders.
Diligent Credentialing Director with proven track record in managing complex programs and improving operational efficiency. Successfully led initiatives that streamlined processes and enhanced team productivity. Demonstrated ability to manage budgets and ensure compliance with organizational policies.
Overview
22
22
years of professional experience
1
1
Certification
Work History
Credentialing Program Administrator
InnovAge PACE
Denver, CO
01.2022 - Current
- Serve as organizational lead for all aspects of provider and entity credentialing, re-credentialing, and privileging across multiple states.
- Design and implement system-wide credentialing policies aligning with NCQA, CMS, URAC, and state requirements; ensure continuous compliance and audit readiness.
- Oversee end-to-end credentialing operations, database management, and verification processes to support a network serving 9,000+ seniors nationally.
- Partner with Medical Director, Credentialing Committee, and Compliance leadership to shape policy changes and quality initiatives.
- Direct process improvement projects, including implementation of credentialing software systems (Cactus, Modio, Symplr), reducing processing time by 30%.
- Prepare documentation and reports for Credentialing Committee, Medical Executive Leadership, and accreditation surveys.
Senior Credentialing Coordinator
InnovAge PACE
Denver, CO
01.2017 - 01.2022
- Managed credentialing lifecycle for multiple regional programs, coordinating initial and re-credentialing per NCQA, URAC, and PACE standards.
- Conducted delegated audits and credentialing file reviews; led file preparation for AAAHC survey, earning commendation for outstanding compliance.
- Developed monitoring systems for licenses, DEA, CME, and board certifications to ensure proactive renewal and zero lapses.
- Trained and mentored new staff in credentialing procedures and compliance standards.
Credentialing Coordinator II
Colorado Access
Denver, CO
01.2016 - 01.2017
- Delivered full-cycle credentialing and re-credentialing for practitioners and facilities, adhering to regulatory requirements and corporate standards.
- Collaborated with senior leadership on automation and compliance audit initiatives.
Credentialing Coordinator
Colorado Pulmonary Intensivists, PC
Denver, CO
01.2014 - 01.2017
- Oversaw credentialing for 16 physicians and 10 allied health staff; maintained all documents and verifications to ensure hospital appointment compliance.
- Managed DEA/licensure renewals, ACLS/BLS scheduling, and committee documentation.
Credentialing Specialist
Rocky Mountain Gastroenterology Associates, PLLC
Denver, CO
01.2004 - 01.2015
- Credentialed over 170 providers for multiple facilities and surgery centers, ensuring compliance with ASC, CAQH, and payer-specific credentialing requirements.
- Directed medical staff committee processes; collaborated with leadership to maintain efficient and compliant operations across five ASC sites.
Education
Bachelor of Science - Healthcare Administration / Management
University of Phoenix
Lone Tree, CO01.2015
Skills
- Microsoft Word, Excel, PowerPoint
- EHR/EMR
- Symplr
- Cactus/Modio
- Verity
- Andros
- Verifiable
- Ready Docs
- Allscripts
- CAQH
- EPIC
- ECHO
- Prophecy
- Morrissey
- OneApp PRO
- Estaff 365
- SQL
- Salesforce
Accomplishments
- Recognized by AAAHC for exemplary credentialing file management (2017, 2018)
- Led multi-state credentialing expansion supporting PACE entry into six new states
- Standardized credentialing policies and automated verifications, achieving a 25% efficiency gain
- Maintained 100% compliance during external surveys and internal NCQA audits
Certification
- Certified Provider Credentialing Specialist (CPCS) – NAMSS | Summer 2026
- National Association Medical Staff Services (NAMSS) – Member
- Medical Group Management Association (MGMA) – Member
- Colorado Association Medical Staff Services (CAMSS) – Member since 2018
- AAPC – Member
CORE COMPETENCIES
- Credentialing & Re-Credentialing Strategy
- Managed Care & PACE Program Operations
- Regulatory Compliance (NCQA, URAC, CMS, TJC, AAAHC)
- Provider Enrollment (Medicare, Medicaid, CAQH, PECOS, NPPES)
- Process Design & Implementation
- Audit Preparation & Survey Management
- Policy Development & Standardization
- Cross-Functional Team Leadership
- Project Management & Performance Optimization
- Quality Assurance | Data Integrity | Risk Mitigation
Timeline
Credentialing Program Administrator
InnovAge PACE
01.2022 - Current
Senior Credentialing Coordinator
InnovAge PACE
01.2017 - 01.2022
Credentialing Coordinator II
Colorado Access
01.2016 - 01.2017
Credentialing Coordinator
Colorado Pulmonary Intensivists, PC
01.2014 - 01.2017
Credentialing Specialist
Rocky Mountain Gastroenterology Associates, PLLC
01.2004 - 01.2015
Bachelor of Science - Healthcare Administration / Management
University of Phoenix