Lindsey Kruse
Denver,CO
Summary
Cross functional leader with over ten years of diverse experience. Adept in analytical thinking, project management, strategic planning, management of staff, and procedures. Proven record of excellent leadership skills, diplomacy, and tact with the ability to maintain and build effective relationships to gain trust and respect across all levels of an organization. My commitment and proven track-record make me an excellent choice for this position.
Overview
12
12
years of professional experience
Work History
Provider Contracting Analyst
Cigna
10.2019 - Current
- Initiate and maintain effective channels of communication with matrix partners including Claims Operations, Medical Management
- Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing and Service
- Manage contracting and negotiations for fee for service with physicians, ancillaries, and hospitals
- Responsible for the evaluation of credentialing/privileging requests and evidence of education, training, competence, and experience against established criteria for practitioners/providers
- Support strategic positioning for provider contracting, assists in the development of networks and helps identify opportunities for greater value-orientation
- Drives change with external provider partners by offering consultative expertise to assist with total medical cost initiatives
- Prepare, analyze, and review projects for financial impact of provider contracts and alternate contract terms
- Contributes to the development of alternative network initiatives
- Supports analytics required for the network solution.
Credentialing Manager/Provider Relations
SurgeOne
10.2017 - 09.2019
- Responsible for all aspects of the credentialing, re-credentialing, and privileging for all new and current providers
- Participate in internal and external audits of practitioner files and operational documents (e.g., policies, procedures, monitoring logs) to maintain compliance with accreditation standards and federal regulations
- Performed as a key liaison between hospital facility, providers, staff, leadership, and vendors
- Collected, verified, analyzed, and delivered practitioner-specific data obtained during the credentialing process for the reviewing and approval bodies to have the information necessary to make decisions
- Created a unified Customer Service team through effective communication, team building, motivation, and recognition
- Supervised, trained, and evaluated staff performance
- Developed clear goals and objectives for performance management and effectively communicated accountability
- Assists in resolving provider service complaints
- Research problems and negotiate with internal/external partners/customers to resolve escalated issues.
A/R Credentialing Specialist
Mental Health Center of Denver
05.2017 - 10.2017
- Responsible for processing an initial, reappointment/recredentialing application by using primary, secondary, or recognized equivalent sources to maintain compliance with accreditation standards and federal regulation
- Performed payer credentialing functions for the organization, assisting the AR Contract Compliance Specialist, and periodic financial intake coordinator duties
- Entered, maintained, and requested provider information in CAQH
- First point of contact for Billers and FICs for credentialing-related questions with claims and eligibility verifications.
Medical Staff Coordinator
Lutheran Medical Center - SCL Health
10.2012 - 08.2016
- Responsible for credentialing initial and reappointment applications for providers and AHP's
- Processed over 400+ applications per year
- Analyzed a reappointment/recredentialing application and supporting documentation for completeness and eligibility according to accreditation standards and federal regulations, and then notify the practitioner of the application status
- Assembled, analyzed, and put together reports for the leadership team
- Excellently maintain meeting minutes, agendas, and calendars for the leadership team to operate efficiently
- Effectively assisted with selecting and onboarding medical staff leadership regarding responsibilities and key policies associated with their role
- Monitored and evaluated practitioner sanctions, complaints, and adverse information between credentialing cycles to maintain compliance.
Education
Bachelor of Science - Business Administration
University of Denver
Denver, COAssociate of Science - Marketing
Metropolitan State University
Denver, COSkills
- High Level of Analytical Ability, Initiative and Judgement
- Project Management
- Business Acumen
- Leadership and Communication
State
CO
City
Greenwood Village
Zip
80111
References
Available Upon Request
Timeline
Provider Contracting Analyst
Cigna
10.2019 - Current
Credentialing Manager/Provider Relations
SurgeOne
10.2017 - 09.2019
A/R Credentialing Specialist
Mental Health Center of Denver
05.2017 - 10.2017
Medical Staff Coordinator
Lutheran Medical Center - SCL Health
10.2012 - 08.2016
Bachelor of Science - Business Administration
University of Denver
Associate of Science - Marketing
Metropolitan State University