Jaime Dirkson
Branchville
Summary
Results-driven Credentialing Manager with expertise in leveraging credentialing software and leading teams to ensure compliance with regulatory standards. Skilled in streamlining workflows and enhancing data integrity while promoting collaboration among stakeholders.
Overview
10
10
years of professional experience
Work History
Credentialing Manager
Lifestance Health
05.2022 - Current
- Lead and oversee all facets of practitioner credentialing, recredentialing, ensuring full compliance with State, Federal and NCQA standards.
- Managed performance oversight ensuring compliance with regulatory standards across all credentialing activities.
- Implemented processes achieving credentialing KPIs through streamlined workflow and adherence to best practices.
- Oversaw preparation and submission of documentation and applications for insurance payers, ensuring timely and accurate compliance.
- Ensure the integrity and accuracy of provider data by conducting regular audits and maintaining a credentialing database and systems with precision and consistency.
- Providing leadership and guidance to a team of 11 credentialing coordinators.
- Plan and lead weekly team huddles to coordinate priorities and deadlines.
Coordinator II
Saint Clare’s-Prime Healthcare
11.2020 - 05.2022
- Tracked expireables, licenses, and malpractice insurance for all providers to ensure compliance and readiness.
- Managed on-call schedules for all departments, facilitating timely coverage and operational efficiency.
- Prepare material, agenda, and minutes for credentials committee meetings and medical executive meetings.
- Collected and processed verification and accreditation information, supporting credentialing accuracy and regulatory adherence.
- Ensure that all information meets legal, federal and state guidelines when processing applications.
- Processed applications for initial applicants and reappointments.
Credentialing Coordinator
Skylands Medical Group
07.2019 - 11.2020
- Managed credentialing and recredentialing for affiliated organizations, medical groups, third party payors, and hospitals, ensuring timely updates of all files.
- Coordinate, monitor and review provider applications as well as accompanying documents to ensure the applicant is eligible.
- Monitored and updated provider CAQH information to facilitate verification and streamline credentialing workflows.
- Compiled and maintained accurate provider data to ensure compliance and support credentialing processes.
Credentialing Specialist
Newton Medical Center-Atlantic Health Systems
03.2016 - 05.2018
- Prepared and maintained reports on credentialing activities, supporting compliance with accreditation, membership, and facility privileges.
- Ensured compliance with legal, federal, and state guidelines during application processing.
- Tracked expireables, licenses, and malpractice insurance for all providers to maintain current credentialing status.
- Processed applications for initial applicants and reappointments.
- Prepare material, agenda, and minutes for credentials committee meetings and medical executive meetings.
Education
Certified Medical Assistant -
Ace Healthcare Training Institute
01-2019
Sussex County Community College
Skills
- Credentialing software
- MD Staff
- EPIC software
- ECHO Data System
- SalesForce
- Microsoft Excel
- Microsoft Word
- Microsoft Powerpoint
- Microsoft Outlook
References
Available upon request
Timeline
Credentialing Manager
Lifestance Health
05.2022 - Current
Coordinator II
Saint Clare’s-Prime Healthcare
11.2020 - 05.2022
Credentialing Coordinator
Skylands Medical Group
07.2019 - 11.2020
Credentialing Specialist
Newton Medical Center-Atlantic Health Systems
03.2016 - 05.2018
Certified Medical Assistant -
Ace Healthcare Training Institute
Sussex County Community College