Jennifer Cloud
North Woodstock,NH
Summary
Accomplished leader in Credentialing Operations with a proven track record at symplr, enhancing business processes and driving growth. Skilled in strategic planning and team leadership, I've successfully increased market share and fostered strong relationships across departments. Expert in policy development and performance data analysis, consistently achieving organizational goals.
Overview
7
7
years of professional experience
2
2
Certifications ( CPCS, CPMSM)
Work History
Vice President, Credentialing Operations
Symplr
09.2023 - Current
- Increased company growth through collaboration with sales and marketing departments. Demonstrated YoY growth of 35%.
- Demonstrated proficient leadership skills to motivate employees and build competent teams enabling those under my care to achieve certification through NAMSS.
- Collaborated with senior management to develop strategic initiatives and long-term goals.
- Collaborated with legal, accounting, and other professional teams to review and maintain compliance with regulatory bodies, such as; NCQA, TJC, and CMS.
- Led the CVO to achieve NCQA CR Accreditation and CVO Certification.
- Comprehensive understanding of industry regulations empowering the development and maintenance of robust policies and procedures.
- Established and maintained strong relationships with customers, vendors, and strategic partners.
- Devised and presented business plans and forecasts to executive leadership.
- Maintained P&L and shouldered corporate fiscal responsibility.
- Analyzed industry trends and tracked competitor activities to inform decision-making.
- Oversaw business-wide changes to modernize procedures and organization.
- Formulated and executed strategic initiatives to improve product offerings.
- Identified opportunities to improve business process flows and productivity.
- Represented the organization at industry conferences and events, such as; NAMSS.
Senior Director, Credentialing Operations
Symplr
03.2022 - 09.2023
- Fostered a work culture of collaboration and inclusion to increase morale and reduce turnover.
- Instituted formal operating procedures driven by NCQA regulatory standards and enforced adherence to policies that impacted the bottom line.
- Drove strategic improvements to enhance operational and organizational efficiencies.
- Directed design and execution of business transformation initiatives to drive performance, profit optimization, and growth opportunities.
- Plan and facilitate training using various technology solutions, including new applications and procedures.
- Led classroom-style training sessions in person, and via video conference
- Met with department supervisors and provided staff support to attain organizational goals.
- Leveraged professional networks and industry knowledge to strengthen client relationships.
- Spearheaded innovative strategies for resource allocation and strategic planning by analyzing FTE distribution with profit margins.
- Successfully managed budgets and allocated resources to maximize productivity and profitability.
- Used industry expertise, customer service skills, and analytical nature to resolve customer concerns and promote loyalty.
- Set aggressive targets for employees to drive company success and strengthen motivation.
- Established performance goals for employees and provided feedback on methods for reaching those milestones.
Director, Credentialing Operations
Symplr
10.2019 - 03.2022
- Spearheaded innovative approaches to resource allocation and strategic planning.
- Leveraged professional networks and industry knowledge to strengthen client relationships.
- Maintained appropriate FTE to customer accounts to promote account success.
- Reduced budgetary expenditures by effectively negotiating contracts for more advantageous terms.
- Handled problematic customers and clients to assist lower-level employees and maintain excellent customer service.
- Analyzes TJC, DNV, AAAHC, NCQA, URAC, and CMS standards and develops criteria to ensure compliance; revises general aspects of credentialing and privileging process as necessary; makes recommendations for and implements changes in policies and procedures.
- Prepares for and coordinates credentialing audits in compliance with the managed care delegated credentialing contracts.
- Functions as primary CVO credentials contact for all internal and external inquiries; develops and maintains positive working relationships.
- Oversees the supervision of personnel, which includes work allocation, training, promotion, enforcement of internal procedures and controls, and problem resolution; evaluates performance and makes recommendations for personnel actions; motivates employees to achieve peak productivity and performance.
- Represents the CVO to internal and external customers as appropriate; makes presentations to and interacts with various internal and external customers on issues pertinent to area of specialty.
- Coordinates the management of the electronic credentials application, to ensure distribution, receipt, processing, and timely delivery to health system entity.
- Coordinates the management of the expirables process to ensure all clinical provider licenses and certificates remain current, ensuring appropriate notification before expiration.
- Monitors and reports turnaround times for processing of credentials applications, with continued focus on delivery of a high-quality product, with the greatest efficiency, in the least amount of time,
Manager, Provider Enrollment and Credentialing
IntelliSoft Group
11.2017 - 03.2019
- Completed provider enrollment for various clients. Reviewed and updated provider/client information in CAQH, completed enrollment applications for BC/BS, Cigna, EyeMed, Medicaid for multiple states, and application processes for over 1000 providers.
- Professional, organized, and safe environment for employees and patrons.
- Developed and maintained relationships with customers and suppliers through account development.
- Cross-trained existing employees to maximize team agility and performance.
- Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
- Accomplished multiple tasks within established timeframes.
- Maximized performance by monitoring daily activities and mentoring team members.
- Managed and motivated employees to be productive and engaged in work.
- Leveraged data and analytics to make informed decisions and drive business improvements.
- Coordinates the management of the electronic credentials application, to ensure distribution, receipt, processing, and timely delivery to health system entity.
- Coordinates the management of the expirables process to ensure all clinical provider licenses and certificates remain current, ensuring appropriate notification before expiration.
- Monitors and reports turnaround times for processing of credentials applications, with continued focus on delivery of a high-quality product, with the greatest efficiency, in the least amount of time,
Education
No Degree - Psychology
Southern New Hampshire University
Hooksett, NHSkills
- Process improvement
- Critical thinking
- Proposals and presentations
- Performance data analysis
- Complex Problem-solving
- Strategic planning
- Team leadership
- Staff development
- Industry best practices
- Policy and procedure development
Certification
Certified Professional Medical Services Management (CPMSM)
NAMSS
2011-Present
Certified Provider Credentialing Specialist (CPCS)
NAMSS
2009-Present
Timeline
Vice President, Credentialing Operations
Symplr
09.2023 - Current
Senior Director, Credentialing Operations
Symplr
03.2022 - 09.2023
Director, Credentialing Operations
Symplr
10.2019 - 03.2022
Manager, Provider Enrollment and Credentialing
IntelliSoft Group
11.2017 - 03.2019
Certified Professional Medical Services Management (CPMSM)
NAMSS
2011-Present
Certified Provider Credentialing Specialist (CPCS)
NAMSS
2009-Present
No Degree - Psychology
Southern New Hampshire University
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