Janette Sampson
Lakewood Ranch,FL
Summary
Organized team leader builds positive rapport, inspires trust and guides teams toward achievement of organizational goals. Dependable professional ensuring data accuracy, Strong facilitator adept at working cross-departmentally with co-management and top-level leadership. Excellent trainer and mentor.
Overview
16
16
years of professional experience
Work History
Team Lead, Provider Data Management Analyst
Imagine360
09.2021 - 06.2024
- Provided leadership and guidance to team members
- Participated and completed professional mentoring program
- Conducted performance appraisals and held regular one-on-one coaching sessions with team members to encourage and promote personal development
- Reviewed and audited completed work to verify consistency, quality, and conformance
- Collaborated with other departments to develop effective solutions that met client needs while prioritizing business and information needs
- Analyzed provider data for discrepancies and errors while developing reports on provider demographics, utilization patterns, and other related metrics
- Managed multiple projects with competing deadlines simultaneously
- Researched and resolved internal and external inquiries regarding provider status and system set-up to ensure quality control
- Monitored claims processing system to identify potential problems with provider data
- Tested and implemented directory for new product
- Trained newly hired staff in relevant processes and procedures.
Provider Data Quality Coordinator, Credentialing Representative
The Health Plan
06.2020 - 07.2020
- Maintained provider records in database with demographics, tax ID, or other changes to ensure accuracy of information
- Assigned/maintained pay class to ensure accurate claims payment
- Entered applications to initiate credentialing cycle and to help ensure timely credentialing of applicants
- Worked collaboratively with internal and external personnel to implement new provider and complex contractual agreements
- Entered newly contracted providers into database to ensure correct claims payment to accurately populate provider directory information
- Researched, reviewed, and updated provider records within database
- Adhered to all policies and procedures of regulatory/governing standards established by NCQA, CMS, BMS, and states of West Virginia and Ohio
- Resolved data entry claims queue issues including data entry of non-participating providers
- Researched and resolved internal and external inquiries regarding provider status and system set-up to ensure quality control
- Worked towards improving existing processes to improve quality and efficiencies
- Conducted audits of provider information and escalated issues for resolution
- Assisted with national, state, and internal audits
- Identified, investigated, reported, tracked and followed-up on all potentially adverse information received from credentialing sources in accordance with established guidelines, and policies and procedures
- Worked to ensure timely and accurate initial and reappointment applications presented to Medical Credentialing Committee.
Administrative Assistant/Billing Clerk
American Renal Associates
03.2020 - 05.2020
- Welcomed office visitors warmly and alerted staff to arrivals of scheduled appointments
- Managed office inventory by restocking supplies and placing purchase orders to maintain adequate stock levels
- Executed billing tasks and recorded information in company databases
- Created improved filing system to maintain secure client data
- Collected data to complete detailed financial reports for management
- Promoted consistent accuracy of billing information by reconciling accounts monthly.
Credentialing Coordinator
MediGold – Nesco Resources Contracting
07.2019 - 12.2019
- Compiled and maintained accurate data for all providers
- Completed and monitored provider credentialing and re-credentialing applications
- Maintained copies of current state licenses, DEA certificates, malpractice coverage and all other required credentialing documents for providers
- Audited health plan directories for accurate provider information
- Maintained accountability for integrity of credentialing information entered the data tracking system
- Communicated the appointment, reappointment, and or changes of providers to any external and internal parties.
Medical Staff Coordinator
CHG Healthcare
01.2019 - 05.2019
- Reviewed provider applications and resumes for consistency and accuracy
- Compiled documents researched and verified provider backgrounds
- Queried and reviewed FSMB and NPDB reports
- Verified requests to references and appropriate sources
- Interviewed provider peer references over the phone about providers clinical performance skills
- Functioned as liaison between medical board and provider when applying for a license, obtaining updates and reporting progress.
Medical Staff Coordinator
WVU Medicine
03.2016 - 06.2018
- Achieved high standards and processes for credentialing data while ensuring database integrity and compliance according to institutional bylaws and regulatory standards
- Tracked research, compiled data, and prepared papers for consideration for credentialing and re-credentialing to committees, physicians, and board of directors
- Served as interdepartmental communication liaison and resource to administrative support staff for potential candidates to medical staff membership, re-credentialing, and additional privileges
- Analyzed and maintained all provider data for primary source verification and accuracy to attain departmental deadlines
- Functioned as liaison with Compliance department and provider to ensure accurate data.
Executive Administrative Assistant/Office Manager
Wheeling Hospital
06.2008 - 03.2016
- Facilitated the daily office operations including the reception area, greeting patients, responding to phone calls, and in-person requests for multiple practices
- Reinforced strict confidentiality and safeguarded patient-related information through HIPPA regulations
- Collaborated with Medicare, Medicaid, and private insurance companies to resolve billing issues
- Administered all insurance billing authorizations and mediated testing scheduling
- Medical coded and posted billing charges within different software programs for upper administration.
Education
Bachelor of Science - Nuclear Medicine
Wheeling Jesuit University
Wheeling, WV12.2007
Skills
- Proficient to lead and influence teams effectively
- Strong organization skills and people management capabilities
- Excellent verbal and written communication skills to articulate complex information clearly
- Expert with data management systems and processes
- Proven experience in managing projects related to data changes, automation, or new product offerings
- Ability to work with cross-functional teams
- Strong analytical qualities to research and solve complex issues
- Proficient use of Microsoft Office applications and internet resources
- Staff education and training
- Daily workflow improvement
- Organization and Time Management
- Excellent Communication
- Planning and Coordination
- Teamwork and Collaboration
- Dependable and Responsible
- Attention to Detail
- Self-Motivated
- Multitasking Abilities
- Problem-Solving
- Analytical and Critical Thinking
Accomplishments
- Mentoring program
Timeline
Team Lead, Provider Data Management Analyst
Imagine360
09.2021 - 06.2024
Provider Data Quality Coordinator, Credentialing Representative
The Health Plan
06.2020 - 07.2020
Administrative Assistant/Billing Clerk
American Renal Associates
03.2020 - 05.2020
Credentialing Coordinator
MediGold – Nesco Resources Contracting
07.2019 - 12.2019
Medical Staff Coordinator
CHG Healthcare
01.2019 - 05.2019
Medical Staff Coordinator
WVU Medicine
03.2016 - 06.2018
Executive Administrative Assistant/Office Manager
Wheeling Hospital
06.2008 - 03.2016
Bachelor of Science - Nuclear Medicine
Wheeling Jesuit University
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