Lauren Kelly
Summary
Experienced administrative professional with 5+ years in provider credentialing services. Works productively with facilities, provider groups and individual professionals. Knowledgeable about application requirements for government and private insurance plans.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Credentialing Specialist
Schweiger Dermatology Group
2021.09 - Current
- Compiles statistical information and data on medical staff and allied health professionals
- Communicates results and status of the applications to physicians, payers, managers, and co-workers
- Maintains credentials database(s) to identify and disseminate to others (onboarding, provider enrollment, recruiting, scheduling, contracting) hospital privilege / approval report status
- Completes payer-provider enrollment process, performs revalidation's, maintains CAQH profiles
- NPPES registrations, provider data with payers, and managing plan enrollment status in the credentialing system
- Maintains current knowledge of credentialing standards and regulations to ensure compliance at a national level
Credentialing Specialist
Montefiore Health System
2018.03 - 2021.09
- Worked closely with CMO personnel and medical staff to provide first line quality assurance in the processing of credentialing and re-credentialing applications in accordance with regulations and requirements to ensure compliance
- Aided in the Medicare and Medicaid enrollment for all medical staff
- Responded to inquiries from other healthcare organizations, interfaced with internal and external customers on day-to-day credentialing issues
- Managed and maintained all faculty appointments and promotions for new and existing providers
- Processed resignations and change of status for all providers
- Maintained confidential provider files in accordance with the Joint Commission requirements by ensuring documents with expiration dates were up to date
- License registration, DEA, board certifications etc.
Special Education Paraeducator
Irvington High School
2013.09 - 2017.10
- Conceptualized students IEP goals and reported progress of performance and behaviors to the supervising teacher
- Led students understanding of classroom rules and procedures and assisted students by answering questions, providing proper examples, emotional support, friendly attitude and general guidance
- Built extensive knowledge of, and ability to, perform duties in full compliance with all districts, Board of
- Education, State and Federal laws, methods, requirements, policies, procedures and activities pertinent to the duties of the position
Medical Assistant
Westmed Medical Group
2012.02 - 2013.08
- Worked as a team member to assist doctors in providing the highest level of care to patients to support a cohesive work environment
- Provided patients with personalized assistance—medical and emotional—resulting in more individualized medical care
- Conducted patient interviews for history and chief complaints
- Performed computer skills in patient billing, data entry and patient documentation
Medical Assistant
White Plains Pediatric Group
2008.12 - 2009.05
- Led patient care by taking vitals and appropriately documenting the needs or concerns of the patient
- Processed lab orders, transmitted requisitions and completed insurance claim forms
- Maintained supplies and equipment by ordering items when low
Education
Master of Public Administration - Health Services Management
Mercy University
Dobbs Ferry, NY02.2021
Bachelor of Science - Behavioral Science/Health Services Management
Mercy University
Dobbs Ferry, NY05.2017
NHA Certified Medical Assistant -
Southern Westchester BOCES
Elmsford, NY01.2012
Skills
- Provider Relations
- Credentialing Documentation
- Microsoft Office
- Regulatory Compliance
- Database Maintenance
- Management Collaboration
- Group Assistance
- Credentialing Requirements
- Verbal and Written Communication
Certification
- Licensed Notary Public
Timeline
Credentialing Specialist
Schweiger Dermatology Group
2021.09 - Current
Credentialing Specialist
Montefiore Health System
2018.03 - 2021.09
Special Education Paraeducator
Irvington High School
2013.09 - 2017.10
Medical Assistant
Westmed Medical Group
2012.02 - 2013.08
Medical Assistant
White Plains Pediatric Group
2008.12 - 2009.05
Master of Public Administration - Health Services Management
Mercy University
Bachelor of Science - Behavioral Science/Health Services Management
Mercy University
NHA Certified Medical Assistant -
Southern Westchester BOCES
- Licensed Notary Public
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