Kathleen O'Donnell
Downingtown,PA
Summary
Experienced and detail-oriented professional with 10+ years experience in provider credential services. Works productively with facilities, provider groups and individual professionals. Competencies include Microsoft Office and Google Sheets experience, relationship building, strong interpersonal skills and exceptional written and verbal communication skills. Goal oriented and committed to meeting department deadlines through time management and problem resolution. Able to function well independently or as part of a team.
Overview
2024
2024
years of professional experience
Work History
Provider Credentialing Specialist
Genesis HealthCare
1 1 - Current
- Responsible for centralized credentialing for all Licensed Independent Practitioners (LIPs) who attend, consult or provide telephone coverage at Genesis Healthcare owned/managed centers
- Initiate initial application process – tracking file through the recredentialing process
- Analyze process and resolve issues to assure completion of the credentialing and recredentialing operation according to established standards and timelines
- Consistently met and/or exceeded individual productivity metrics, quality and timeliness standards as defined by department service standards
- Review, process and analyze practitioner initial and recredentialing applications and accompanying documents, ensuring applicant eligibility
- Query, maintain and track all time-sensitive documents such as State License, DEA Certificate, Professional Liability Insurance, Controlled Drug Substance Certificate when applicable, Board Certification, Work Permit/Temporary Resident Card to ensure timely renewals
- Identify red flags that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up
- Notify information systems, administrator, medical directors and/or Genesis Physician Services when a credentialing file is complete in all respects
- Interface with practitioners and outside sources such as managed care plans, licensing boards, National Practitioner Data Bank and other agencies to ensure appropriate information is maintained and updated
- Maintain knowledge and compliance with company policy, all state and federal regulatory requirements as well as accrediting organizations (Joint Commission, Commission on Accreditation of Rehabilitation Facilities for all providers)
- Establish and maintain provider information via web-based online credentialing system
- Respond to inquiries from other healthcare organizations.
- Skilled at working independently and collaboratively in a team environment
- Proven ability to learn quickly and adapt to new situations
- Self-motivated, with a strong sense of personal responsibility
Account Assistant
Davlyn Manufacturing Co., Inc
06.2010 - 12.2010
- Performed general administrative and clerical duties, including client invoicing.
Recovery Assistant
Recovery Services International
06.2009 - 10.2010
- Worked effectively with the cashiering team to ensure proper handling of recovery checks
- Analyzed and allocated recovery checks using the PCRS system
- Prepared daily deposit slips for recovery checks and performed reconciliation
- Prepared month end reports for internal stakeholders and mailed reports to clients
- Called vendors, i.e., hospitals, lawyers, doctors, regarding checks received with insufficient file information
- Assisted in preparing and sending certified letters to attorneys and claimants
- Maintained sufficient office supplies and ordered materials as needed for two insurance departments
- Demonstrated ability to adapt and learn quickly
- Identified and logged department checks and correspondence to the AS400 system
- Created new claimant profiles using information from Case manager work papers and followed up with incomplete work paper details
- Released and managed daily fist demand letter to claimants, ensuring that copies went to proper files and debtors
- Maintained file room, which included filing new paper work and purging old files as demanded
- Prepared invoices for accounts payable
- Trained new employees.
Education
Liberal Arts, Media
Delaware County Community College
2000
Skills
- Experience with Echo Credentialing and CAQH
- Computer Skills including MS Word, Excel, Google Sheets and credentialing software knowledge
- Database skills including querying, reporting and document generation
- Experience with HIPAA and Confidentiality
- Exceptional Interpersonal Skills
- Self-motivated with high level of attention to detail
- Microsoft Office
- Confidential Records Management
- Solo Practitioner Credentialing
- Remote Conferencing and Communication
Timeline
Account Assistant
Davlyn Manufacturing Co., Inc
06.2010 - 12.2010
Recovery Assistant
Recovery Services International
06.2009 - 10.2010
Liberal Arts, Media
Delaware County Community College
Provider Credentialing Specialist
Genesis HealthCare
1 1 - Current
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