JEANINE MARTIN
Trinity,FL
Overview
16
16
years of professional experience
Work History
Credentialing Manager/Provider Network Management
Access Healthcare Physicians LLC
Spring Hill, FL
03.2017 - Current
- Responsible for building, training, and management of credentialing team
- Conducts onboarding activities with new providers - employed and affiliate
- Holds weekly team huddles and individual goal setting sessions with team
- Created processes to ensure timeliness and efficiency of tasks assigned
- Conducted audits of all work and offered additional training as needed
- Attended monthly meetings with senior leadership to assist with provider network management issues
- Organized and implemented a process for open enrollment panels for PCP providers
- Reports directly to CEO and CMO
- Executes and implements new contracts with payors
- Works closely with billing departments to ensure revenue cycle success
- Assists Operations Department with roster issues and patient assignments
- Maintains provider network directories and panels
- Builds relationships with plan provider reps keeping lines of communication open
- Attends provider meetings to answer questions and provide assistance
- Assists with patient assignment issues
- Educates staff in offices on plans accepted
- Works closely with billing team to rectify denials
Delegated Credentialing Specialist/Credentialing Coordinator
Access Healthcare Physicians LLC
Spring Hill, FL
12.2012 - 03.2017
- Solely responsible for Wellcare delegated credentialing for the entire company, 2 entities, 160 providers (All Specialties & Types)
- Performs credentialing/re-credentialing activities for all providers in accordance with NCQA standards.
- Completes monthly monitoring activities and primary source verification for all credentialed providers
- Holds monthly credentialing committee meetings with Medical Directors
- Scored 100% on past two annual audits from Wellcare, Humana, and Anthem
- Headed the development of a credentialing database as Project Manager and Subject Matter Expert
- Fluent with Medicare/Medicaid enrollment and re-enrollments, PECOS
- Manages CAQH profiles and re-attestations
- Assists credentialing dept with enrollments of all plans
- Processes applications quickly and accurately to ensure fast loading
- Coordinates efforts with Operations and Corporate Development teams for onboarding of new providers to guarantee smooth transition
- Consultant to credentialing dept. for troubleshooting issues during load processes
- Assisted in building the credentialing dept which included hiring and training of new coordinators
- Attends provider meetings to answer questions and provide assistance
- Builds relationships with plan provider reps keeping lines of communication open
- Highly skilled at hospital credentialing with in-depth knowledge of JCAHO standards
- Assists with obtaining new plan contracts and renegotiating existing contracts and rates
Referral/Authorization Coordinator
Access Healthcare Physicians LLC
Spring Hill, FL
05.2009 - 12.2012
- Responsible for the processing of all outgoing referrals and authorizations for 800+ patients in busy PCP offices
- Reviewed all requests for medical necessity before presenting to provider for approval
- Obtained clinical information from specialist offices to support need for referral
- Fluent with diagnosis and procedure code terminology (ICD-9, ICD-10, CPT, HCPCS)
- Worked with plans to ensure quick processing
- Patient communications throughout process so all parties informed
- Asked by corporate to write procedures for company based on my processes
- Coached and trained other coordinators on proper procedures and updates
Timeline
Credentialing Manager/Provider Network Management
Access Healthcare Physicians LLC
03.2017 - Current
Delegated Credentialing Specialist/Credentialing Coordinator
Access Healthcare Physicians LLC
12.2012 - 03.2017
Referral/Authorization Coordinator
Access Healthcare Physicians LLC
05.2009 - 12.2012