Larissa Kinner Neils
Bowie,MD
Summary
Seasoned Specialist offering 19 years of comprehensive experience interpreting and implementing quality assurance standards and investigating background to make security determinations for granting security clearances. Processing and management of Personal Verification credentials in accordance with Government guidelines to enhance security, reduce identify fraud and protect personal privacy by assisting with government wide standards.
Overview
5
5
years of professional experience
Work History
Provider Credentials Specialist 1
CareFirst
02.2022 - Current
- Analyses credentialing application to perform the primary source verification, determines the appropriate networks for participation and obtains the appropriate executed contracts to effectuate the professional relationship and structures the provider group accordingly
- Responds to external and internal inquires regarding provider participation eligibility and criteria
- Maintains the provider file in a provider information control inventory workflow system and electronic provider files with updated provider information during processes
- Responsible for identifying, analyzing, and resolving immediate and existing provider file issues, payment issues
- Processes provider file inputs in accordance with applicable state and federal laws and department guidelines.
Credentials Specialist
Stginternational
07.2021 - Current
- Processing and Management of Personal Identity Verification Credentialing in accordance with our company regulations
- Initiation, analysis, and adjudication of background investigation to make suitability/fitness determinations for continued employment with or in support of the federal government
- New provider enrollment for ICE facilities, works to enroll provider for IHSC contract to place qualified provider, Physicians, Social workers, Nurse practitioner, Nurses, BHT, RT, ect to provide services.
Credentials Specialist
Saratoga Medical (Contractor for Defense Health Agency)
10.2021 - 12.2023
- Assist with Policy Department to develop new policies that will be used in the transition of independent credentialing centers throughout the military to centralized credentialing
- Assist Director with meetings, research, and audits of CCQAS.
Sr. Credentials Coordinator
Prince George’s Hospital Center
09.2019 - 06.2021
- Verified credentials of Medical Staff
- Maintained licensure and certificates including medical licenses, DEA registrations, CDS registration, Board certification and hospital affiliations
- Worked with internal and external auditors during revalidation/recertification
- Worked with internal and external credentialing teams to maintain/initiate the medical appointment of medical staff to different facilities
- Kept close record of all CME, corresponding privileges, and transcripts for medical staff
- Responsible for communication with all staff on an as‐needs basis to maximize AR efforts to ensure the record of each medical staff member remains in good standing
- Monthly conference meeting with The Credentials Committee to assess overall progress of credentialing as well as where in pertains to AR
- Worked extensively with management to keep file maintenance accurate and up to date.
Education
Medical Administration, Healthcare Management -
University of Phoenix
07.2009
Medical Administration -
Fleet Business School
07.1994
General Studies -
Bowie High School
06.1988
Skills
- Communicate effectively, both orally and in writing
- Program planning and implementation of skills
- Knowledge of related accreditation and certification requirements
- Monitor Joint Commission, NCQA and URAC, CMS Federal and State required inspections compliance
- Knowledge of medical credentialing and privileging procedures and standards
- Ability to analyze, interpret and draw inferences from research findings, and prepare reports
- Working knowledge of clinical and/ or hospital operations and procedures
- Ability to use independent judgment to manage and impart confidential information
- Database management skills including querying, reporting, and document generation
Timeline
Provider Credentials Specialist 1
CareFirst
02.2022 - Current
Credentials Specialist
Saratoga Medical (Contractor for Defense Health Agency)
10.2021 - 12.2023
Credentials Specialist
Stginternational
07.2021 - Current
Sr. Credentials Coordinator
Prince George’s Hospital Center
09.2019 - 06.2021
Medical Administration, Healthcare Management -
University of Phoenix
Medical Administration -
Fleet Business School
General Studies -
Bowie High School