LauRay McLain
Topeka,Kansas
Summary
Dynamic Credentialing Account Advisor with a proven track record at Symplr, excelling in provider enrollment and compliance. Adept at managing complex credentialing processes while delivering exceptional customer service. Strong communicator and trainer, committed to enhancing operational efficiency and ensuring regulatory adherence in fast-paced healthcare environments.
Overview
20
20
years of professional experience
Work History
Credentialing Account Advisor
Symplr
Houston, Texas
06.2023 - 10.2025
- Resolved customer inquiries and issues through effective communication.
- Verified provider credentials for accuracy and compliance with regulatory standards.
- Managed application processes for new healthcare providers and staff members.
- Collaborated with medical staff to gather necessary documentation for credentialing.
- Conducted background checks and verified professional licenses and certifications.
- Maintained updated records in credentialing databases and management systems.
- Trained new team members on credentialing processes and system usage.
- Ensured timely completion of credentialing processes by providing guidance to providers on required documentation.
- Reviewed and processed credentialing applications to ensure accuracy, completeness, and compliance with all accreditation standards.
- Performed primary source verifications such as criminal histories, licenses and board certifications.
- Processed re-credentialing applications for existing providers according to contractual requirements.
- Provided support in responding to inquiries from external parties regarding credentialing information.
- Maintained informational resources, tracking and documenting requests for updates, certification and credentialing.
- Checked applications for missing information and organized all paperwork.
- Maintained detailed records of provider data in the credentialing database system.
- Coordinated with internal departments such as medical staff services or risk management to resolve any issues identified during the verification process.
- Participated actively in special projects or initiatives pertaining to improvement of operational efficiency within the department.
- Processed documents and status-change requests, conducting followup assessment regarding enrollment inquiries.
- Collaborated with internal teams regarding provider contracts and agreements.
- Served as a resource person for staff members seeking assistance in understanding complex regulatory requirements related to provider enrollment processes.
- Organized records to prepare for site visits by representatives and associated audits.
- Trained junior credentialing staff on best practices and company-specific procedures.
- Monitored expiration of licenses and certifications, notifying providers of renewal requirements.
- Coordinated with healthcare professionals to collect necessary documentation for credentialing.
- Assisted in the accreditation process by gathering and submitting required documentation.
- Ensured strict confidentiality of provider information in accordance with HIPAA regulations.
- Managed end-to-end provider credentialing process, ensuring compliance with industry standards.
- Provided guidance and support to new providers throughout the credentialing process.
Billing & Authorizations Specialist
Caregivers
Topeka, Kansas
08.2022 - 06.2023
- Completed day-to-day duties accurately and efficiently.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
- Prioritized and organized tasks to efficiently accomplish service goals.
- Assisted with customer requests and answered questions to improve satisfaction.
- Collaborated closely with team members to achieve project objectives and meet deadlines.
- Worked with cross-functional teams to achieve goals.
- Provided support and guidance to colleagues to maintain a collaborative work environment.
Provider Enrollment Specialist II
Medallion Health Group
San Francisco, CA
11.2021 - 05.2022
- Maintained provider enrollments in Medicare and Medicaid across all states.
- Accurately inputted provider effective dates into enrollment system using Medallion Platform..
- Utilized effective active listening, interpersonal and communication skills in collaborating with different individuals on daily basis.
Provider Enrollment Specialist II
Envision Healthcare
01.2018 - 11.2021
- Facilitate a high volume of provider enrollments with Medicare, Medicaid, and divisional insurance payers
- Developed a working knowledge of payer policies for multiple states
- Strong knowledge base of payer requirements and forms
- Maintained and worked reports of non-compliant providers and held A/R
- Trained new
- CSR's on enrollment processes
- Maintained provider files and credentials to facilitate enrollment.
- Utilized effective active listening, interpersonal and communication skills in collaborating with different individuals on daily basis.
Case Worker II
Health Management Services
03.2016 - 03.2017
- Estate functions involving KS and MO deceased Medicaid beneficiaries
- Intake, claims review, probate research, asset research and document review
- Professional interaction with incoming phone| 1
- Followed strict policies and procedures to maintain client confidentiality and keep data private.
- Collections request from probate process and recovery from estates.
- Maintained updated progress notes and case record and documented progress in recovery activities, plans and estate assets.
Education
Kaw Area Technical School
06.1993
Timeline
Credentialing Account Advisor
Symplr
06.2023 - 10.2025
Billing & Authorizations Specialist
Caregivers
08.2022 - 06.2023
Provider Enrollment Specialist II
Medallion Health Group
11.2021 - 05.2022
Provider Enrollment Specialist II
Envision Healthcare
01.2018 - 11.2021
Case Worker II
Health Management Services
03.2016 - 03.2017
Kaw Area Technical School