Jill Levy
Henderson,NV
Summary
Credentialing professional with keen eye for detail and commitment to maintaining high standards. Proven track record in managing credentialing and privileging workflows and improving operational efficiency. Emphasizes team collaboration and adaptability to meet dynamic organizational needs. Highly skilled in compliance management and process optimization, with reliable and flexible approach.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Credentialing Manager
Horizon Specialty Hospitals
Las Vegas, NV
10.2021 - Current
- Managing more than 500 providers for an LTAC, associated rehab hospitals and SNF, while implementing and maintaining rigorous quality standards.
- Onboarding, processing and auditing the initial and re-appointment applications, from inception through approval, ensuring compliance with State, CMS and TJC accreditation standards.
- Compiles, audits and presents completed provider credentialing files to the Medical Executive and Board Committees, making recommendations based on the information curated during the credentialing process.
- Acts as a liaison between the providers, executives and board members, in order to establish and maintain strong working relationships, while representing the organization in a positive and professional manner.
- OPPE/FPPE data collection and management, vaccination tracking and facility recredentialing with federal and commercial insurances.
- Handles all updates in MD-Staff, including application updates, document expirables and troubleshooting any database issues. Tracking metrics for performance improvements and upholding organizational standards.
- Streamlined credentialing processes to enhance efficiency in provider onboarding.
Credentialing Manager
Expert Medical Services
Henderson, NV
06.2019 - 08.2021
- Responsible for the direction, coordination, and work load for each employee and overall functioning of the entire office and the Credentialing Dept.
- Implemented a benefits package for all employees in the company and acted as Benefits Administrator managing the 401K and employer offered medical, dental and vision insurance plans.
- Managed credentialing onboarding for all new physicians and provider groups across the country. Worked closely with providers to contract and credential them with government and commercial insurance companies. Applied for initial privileges and completed re-appointments at acute care hospitals, SNFs, LTACs and Rehab hospitals.
- Applied for state medical licenses for providers and business licenses for companies, renewing or updating medical licensure and certifications, EFT updates, NPPES updates, address and banking updates, etc.
- Established office policies, procedures and guidelines, while making sure each employee followed and maintained these, as required. Recruited and trained new staff. Assisted in recruiting and bringing aboard new clients. Acted as the company HR Dept.
- Delegated workloads and made sure staff had everything needed to complete the work, as required.
- Worked closely with the Billing Dept. to rectify any issues causing denials.
Credentialing Supervisor
Expert Medical Services
Henderson, NV
04.2018 - 06.2019
- Managed the workload for the Credentialing Department. This included, but was not limited to, managing the MSO for three hospitals (two of which were rehabilitation hospitals) and completing the credentialing and privileging for multiple provider groups. Created and updated DOPs, hospital specifics and internal documentation.
- Audited and took files to Credentialing Committee, MEC and Board Committee for three hospitals. Prepared the files for MEC, attended committee meetings where files were approved and then prepared and sent approval letters, updated the credentialing database and made sure to track affiliation dates.
- Assisted with Peer Review for two hospitals and helped to get providers into the EHR system properly, while keeping the floor book current after initials and reappointments were completed.
- Worked closely with physician groups to contract and credential providers with multiple insurance companies. Applied for privileges at all local hospitals, applied for state licenses in other states, and assisted providers renewing or updating licensure.
- Kept track of all Credentialing Specialists’ workloads and made sure everything was completed per established policies and procedures. Trouble shot issues with credentialing software. Recruited and trained new staff. Delegated new work, as it came in and made sure staff had everything needed to complete the work, as requested.
- Ensured all work was in compliance with TJC and all new policies and procedures met specific requirements of the facilities and credentialing bodies.
Sr. Credentialing Representative
Southwest Medical Associates/Part of OptumCare
Las Vegas, NV
09.2014 - 04.2018
- Onboarded more than 100 specialist, hospice, hospitalist and radiology providers, which included, but was not limited to obtaining hospital privileges, enrolling providers with 3rd party payers, credentialing and re-credentialing with the health plan, and tracking applications to completion.
- Processed initial and reappointment files for both SMA Surgery Centers, which included: application review, all primary source verifications, file review, audits, and handling DOP-Sub Committee, Board approvals, PNC committees, minutes, temps and full privileges approval letters, all notifications, tracking, accreditation surveys, etc...
- Detailed, specific knowledge of Medicare and Medicaid initial enrollments, re-enrollments, reassignments, follow-up, data collection, etc. for providers on paper, online portals and in PECOS.
- Ability to create, complete, track and update CAQH, ProviderSource, state specific paper credentialing and re-credentialing applications, NPI (NPPES) records, initial applications and renewals for state licensing applications (for physicians and AHPs), DEA licensing, Pharmacy licensing, etc...
- Charged with applying for initial privileges and completing re-appointments at hospitals for MD, DO, and AHP providers, including delineation of privileges for more than 12 different specialties. This also included helping these providers renew their state medical licensure, DEA, and CDS certifications.
- Tracking and database management utilizing CACTUS, PeopleSoft and other credentialing software.
Credentialing Manager
American Optical Services/Exela Hearing Services
Las Vegas, NV
06.2013 - 06.2014
- Managed the credentialing, contracting, enrollments, and PSV for multiple Optical and Audiology practices, consisting of providers and facilities in more than 14 states across the country and for more than 100 providers.
- Detailed, specific knowledge of Medicare and Medicaid initial enrollments, reenrollments, reassignments, follow-up, data collection, etc. for both facilities and providers on both paper, in PECOS, ProviderSource, Medicaid’s portal and utilizing OneApp Pro.
- Ability to create, complete and update CAQH, ProviderSource, state specific paper credentialing and re-credentialing applications and NPI (NPPES) records.
- Charged with applying for privileges and completing reappointments at hospitals all over the country for MD and DO providers, including delineation of privileges. This also included helping these providers renew their state medical licensure, DEA, and CDS certifications.
- Confident in ability to properly prepare providers and office staff for HIPAA compliance testing and prep, along with accreditation and QA prep.
- Restructured the Credentialing Dept. in order to streamline and improve the credentialing and process.
- This included creating P&P’s, tracking application submissions through to completion and managing the OneApp Pro database.
Education
No Degree - Psychology
Boise State University
Boise, IDNo Degree - Biology
University of Redlands
Redlands, CASkills
- Credentialing software/applications, including: MD-Staff, CACTUS, eVIPS, OneApp Pro, ReadyDoc, ProviderSource, PECOS, CAQH, Availity, etc
- Accreditation Standards, including NCQA, URAC, TJC, AAAHC
- HIPAA Compliance
- Issue and conflict resolution
- Highly organized with a meticulous attention to detail
- Mac and PC platforms
- Microsoft Office: Access, Excel, Outlook, PowerPoint, Publisher and Word
- Strong communication and people skills
- Troubleshooting
- Flexibility
- Working collaboratively
- Critical thinking
- Benefits and payroll management
- Provider enrollment
- Application processing
- Documentation review
- Accreditation compliance
- Data management
- License monitoring
- Credential verification
- Organizational skills
Certification
- Licensed/Bonded Notary Public
- Studying for CPCS and CPMSM certifications
Timeline
Credentialing Manager
Horizon Specialty Hospitals
10.2021 - Current
Credentialing Manager
Expert Medical Services
06.2019 - 08.2021
Credentialing Supervisor
Expert Medical Services
04.2018 - 06.2019
Sr. Credentialing Representative
Southwest Medical Associates/Part of OptumCare
09.2014 - 04.2018
Credentialing Manager
American Optical Services/Exela Hearing Services
06.2013 - 06.2014
No Degree - Psychology
Boise State University
No Degree - Biology
University of Redlands
Section name
- Additional relevant work history available upon request.
Currently studying for NAMSS CPCS certification and soon the CPMSM certification
Currently studying to become CPCS certified and soon after, CPMSM certified.