Janell Carter
Memphis,TN
Summary
Diligent professional with a robust background in credentialing processes and compliance management, specializing in the healthcare sector. Proven track record of effectively managing credentialing for a diverse range of healthcare providers while ensuring strict adherence to regulatory standards. Expertise in meticulous documentation and fostering strong communication with credentialing entities contributes to streamlined operations and enhanced compliance outcomes. Committed to upholding the highest standards of quality and integrity in all credentialing activities.
Overview
30
30
years of professional experience
Work History
Medical Credentialing Specialist
Amedisys
01.2017 - Current
- Serve as a subject matter expert and key contributor in the credentialing department, supporting accuracy, compliance, and workflow optimization.
- Take ownership of complex work streams including CAQH enrollment, payer applications, and provider data management.
- Managed over 50 client accounts daily. Which includes verification, follow-up, and processing per day for client accounts.
- Analyze data to identify credentialing delays and implement process improvements to eliminate barriers to care.
- Draft and maintain standard operating procedures (SOPs), ensuring consistency and compliance across credentialing activities.
- Manage escalated issues involving payer delays, credentialing errors, or missing documentation, working to resolve them efficiently.
- Provide training and support to new team members, assisting in onboarding and mentoring to ensure a strong understanding of processes and expectations.
- Managed credentialing processes for healthcare providers, ensuring compliance with regulatory standards.
Medical Claims Specialist
Quintessence
01.1996 - 01.2019
- Supervised and coached junior claims associates, providing regular performance feedback and assisting with complex case reviews.
- Monitored productivity and quality assurance metrics, identifying trends and performance gaps to address with individual coaching.
- Created internal process documentation and knowledge resources to support consistent, high-quality service delivery.
- Resolved high-priority escalated claims and acted as a liaison between providers, beneficiaries, and internal departments.
- Collaborated with leadership to enhance claims handling procedures and ensure alignment with strategic organizational goals
- Increased revenue capture by 20% and reduced claim denial rates by 15% by auditing and submitting over 150 high-complexity medical claims weekly, ensuring strict adherence to ICD-10 and CPT coding guidelines.
Education
Associate of Science - Medical Billing And Coding
Southwest Community College
Memphis, TN12-2025
Bachelor of Arts - Business Administration And Management
Liberty University
Lynchburg, VA05.2016
Skills
- Team performance tracking and coaching
- SOP creation and process improvement
- Microsoft Office Suite (Excel, Word, Outlook) – Advanced
- Data analysis and reporting
- EMR and CRM platforms
- Provider enrollment
- HIPAA compliance
- Data management
- Credential verification
- License verifications
- Background checks
Timeline
Medical Credentialing Specialist
Amedisys
01.2017 - Current
Medical Claims Specialist
Quintessence
01.1996 - 01.2019
Associate of Science - Medical Billing And Coding
Southwest Community College
Bachelor of Arts - Business Administration And Management
Liberty University