Summary
Overview
Work History
Education
Skills
Timeline
Generic

Maryann Walston

Brooklyn,MD

Summary

Experienced Credentialing Specialist with solid expertise in managing and verifying credentials for healthcare providers. Strong focus on team collaboration and achieving results. Reliable and adaptable, meeting organizational standards and compliance requirements. Skilled in data management, regulatory compliance, and communication.

Overview

18
18
years of professional experience

Work History

Independent Contractor

Various Companies
06.2016 - Current
  • I enjoyed working for delivery apps, including Uber, Lyft, Door Dash, Postmates, Instacart and a few others.
  • Able to work independently and gained some very important customer service skills
  • Customer service
  • Punctuality
  • Safe Driving
  • Patience
  • Time management

Credentialing Specialist II

Avesis, Incorporated
09.2023 - 01.2025
  • Receives and processes incoming applications and supporting credentials from providers
  • Perform the primary source verification according to departmental policies and NCQA standards when not completed by CVO
  • Led initiatives to enhance system integrations, improving data accuracy across platforms used in credentialing workflows.
  • Managed multiple priorities effectively, resulting in the on-time completion of credentialing tasks for numerous providers simultaneously.
  • Conducted audits of provider files, ensuring all necessary documents were up-to-date and compliant with regulatory requirements.
  • Evaluated existing credentialing processes, implementing improvements that increased operational effectiveness and compliance rates.
  • Enhanced credentialing processes by streamlining documentation and verification procedures.
  • Achieved greater accuracy in database management by regularly updating provider records and tracking status changes.

Medical Staff Credentialing Coordinator

Baltimore Medical System, Inc
06.2015 - 05.2018
  • Responsible for all appointments and reappointments in accordance with the departmental policies and procedures, and in compliance with applicable State and Federal laws and regulations, as well as Joint Commission guidelines. I complete the entire credentialing process from start to finish for the health system's Medical Doctors, Psychologists, Nurse Practitioners and social workers.
  • Administrator of Echo, which is the Credentialing database used to store all provider information. I create a record for each provider and enter all essential credentialing information. I am responsible for entering and updating each provider's information into the database and verifying all information is up to date and accurate.
  • Competing all primary source verifications online. The verification websites include NPDB (National Provider Data Bank), OIG, SAM, Maryland Opt-out and Medicaid Sanctions verifications, State Medical license, DEA and CDS verifications.
  • I was responsible for keeping the provider directory on the BMS website up to date. This responsibility involved sending updated information for new providers to be displayed on the BMS website on a monthly basis. I would also send updated reports including departures to have providers removed from the website.
  • I was responsible for preparing all Privileging files each month for review by the Medical Review Committee. I created overall summaries for each file being reviewed and prepared all materials for review including Agendas. I was responsible for documenting minutes for all Medical Review Committee meetings.
  • I worked with a Credentialing Consultant to update all BMS Privileging policies and procedures, Privileging applications and created a Training manual for the Privileging Coordinator position.
  • I was responsible for all Credentialing audits and received 100% on all audits completed. During my employment, I was responsible for assisting BMS in obtaining a Delegated Agreement for Credentialing with Amerigroup Insurance. I completed all requirements set forth by Amerigroup and BMS successfully obtained the Delegated Agreement.
  • I was responsible for all Privileging and Credentialing matters when the Joint Commission survey was conducted. The surveyors stated that the Privileging files they selected were the most organized files they had ever seen and were quoted by BMS' CEO as saying the Privileging survey was "Excellent."
  • Served as a resource for departmental staff by maintaining a thorough understanding of current trends and best practices in the credentialing field.
  • Streamlined the credentialing process by implementing an efficient tracking system for medical staff applications.
  • Upheld strict confidentiality standards, safeguarding sensitive provider information from unauthorized access or disclosure.
  • Contributed to risk management initiatives by monitoring expiring licenses, certifications, and insurances, notifying providers of renewal requirements in a timely manner.
  • Strengthened relationships with external agencies by responding promptly to verification requests and inquiries regarding providers'' credentials.
  • Increased efficiency in data management by implementing a user-friendly database system for storing provider information.
  • Collaborated with department heads to develop a comprehensive credentialing policy, ensuring compliance with industry standards.
  • Assisted with managed care auditing processes and performed internal file audits.
  • Minimized potential legal complications by ensuring adherence to federal and state regulations governing healthcare practitioners'' licensure and certification requirements.
  • Maintained up-to-date knowledge of applicable laws and regulations.
  • Identified gaps in existing compliance processes and recommended updates.

Health System Credentialing Coordinator

Sheppard Pratt Health System
11.2014 - 06.2015
  • Responsible for all appointments and reappointments in accordance with the departmental policies and procedures, and in compliance with applicable State and Federal laws and regulations, as well as Joint Commission guidelines. I complete the entire credentialing process from start to finish for the health system's Psychiatrists, Psychologists, Nurse Practitioners and Social workers.
  • Administrator of Echo, which is the Credentialing database used to store all provider information. I create a record for each provider and enter all essential credentialing information. I am responsible for identifying inaccurate or missing data in each record and making corrections to ensure the information in the database is up to date and accurate.
  • Administrator of all websites used for primary source verification. These websites include NPDB (National Provider Data Bank) and the HireRight website, which are used to complete background validation.
  • An overview of the credentialing process includes sending the credentialing application to the provider, receiving and entering the data into our system. When I receive the provider's application and signed release, I verify each provider's education, licensure and certifications, 3 references, work history, hospital affiliations, liability insurance, etc. I complete all primary source verifications according to the departmental policies and Joint Commission standards. I ensure that each completed file is reviewed and approved by the Credentialing Committee, Medical Executive Committee and Board of Trustees within the set time requirements.
  • Responsible for ensuring all Credentialing policies, procedures and the Bylaws are current.
  • Perform follow-up for all pending applications to obtain missing documents and respond to any provider inquiries regarding credentialing status. I thoroughly inspect all information submitted by each provider to identify any red flags that require additional investigation or evaluation and contact the provider to validate any discrepancies.
  • I updated the credentialing process, which lacked efficiency and organization with a new credentialing process, which adheres to current NCQA and Joint Commission standards. I created a Credentialing checklist that displays the date of verification, the date verified, and the expiration date to all of the relevant documentation and primary source verifications in the file.
  • Responsible for completing reappointments for all providers every two years.
  • Responsible for terming providers in the Credentialing database when necessary.
  • Responsible for implementing and ensuring completion of all Focused Reviews and Peer Reviews.
  • Responsible for the Managed Care and Joint Commission audits for all providers in the Health System. During the first 4 months of my employment, I successfully completed 6 Managed Care audits. I received 100% on 5 of the audits and a 99.3% on the 6th audit.

Credentialing Coordinator

Superior Vision
01.2012 - 11.2014
  • Responsible for credentialing half of all initial providers. This included processing applications and sending all credentialing information to our CVO organization.
  • Validated the information on each credentialing application through a series of credentialing websites. I also used the websites to determine if the provider had any history of liability claims or criminal charges. If any issues are found, I typed a summary of the evidence found and submitted the file to the Credentialing Subcommittee for review. I submitted all clean files to the Medical Director for approval and built all approved providers into the system.
  • Covered the receptionist position when necessary and trained 2 new employees to function as the company's receptionist.
  • Assisted the Provider Relations department by providing phone coverage, which involved answering various inquiries and assisting providers resolve miscellaneous difficulties.
  • Assisted the Credentialing Supervisor with various projects that involved running reports from the credentialing database to analyze the validity of the information.
  • Joined the audit team to assist in the completion of numerous Credentialing audits by generating reports from the database, analyzing data, creating spreadsheets, reviewing files and gathering any missing documents to ensure the files were up to date and correct. I also assisted the audit team by completing internal file audits upon completion of credentialing.

Patient Care Coordinator

Home Physicians, Chesapeake
08.2012 - 01.2013
  • Called and explained to each patient what the health assessments were and if they chose to have the assessment completed, I would coordinate with the Doctor to schedule a visit to the patient's home to complete a health assessment.
  • Scheduled appointments for 3 different providers who worked from Monday through Saturday. The number of appointments varied between 20-30 per day.
  • After scheduling a patient, I would verify their information and enter their data into the Nextgen software. I printed each provider's schedule, create a map showing their travel arrangements to each appointment based on time and location, and e-mail them to each provider on a daily basis.

Inpatient Financial Counselor

Northwest Hospital
02.2012 - 08.2012
  • Verified insurance for patients who required inpatient hospital services. The insurance was corroborated through Electronic Verification Software for all insurance carriers.
  • After verifying each patient's insurance, I entered each patient's data into the Medipac computer system. Once finished, I submitted the information to the Billing department.

Patient Service Coordinator

Central Maryland Urology Associates
03.2011 - 01.2012
  • Entered patient data into Allscripts Professional EHR software and scheduled appointments using Medical Manager software.
  • Scheduled patient appointments and called patients to remind them of their upcoming appointments. I acted as a liaison between several different Doctors and their patients.
  • Registered new patients and updated existing patient demographics in the systems. I verified insurance information to determine each patient's eligibility for health services.
  • Called and/or faxed prescriptions in for patients on the doctor's behalf.

Executive Administrative Assistant

Beco Management, Inc
06.2007 - 12.2011
  • Responsible for various duties related to payroll, Accounts Payable and Accounts Receivable responsibilities.
  • I worked with several members of the Accounting department to gather data in order to create current expense reports and complete weekly projects.
  • Scheduled and coordinated meetings, interviews, appointments, events and other activities for Executives.

Education

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Seton Keough High School
Baltimore, MD

Skills

  • Expert in Microsoft Office tools
  • Excellent written and verbal communication
  • Data entry proficiency and accuracy maintained during database management
  • Knowledgeable in many Credentialing software applications [CAQH, EPIC, Symplyr, PECOS, NPPES]
  • Knowledge of Credentialing standards from NCQA, URAC and The Joint Commission
  • Understanding of Credentialing compliance requirements and cycles
  • Able to organize and prioritize various projects to adapt in fast-paced environments
  • Proficiently audit records to ensure compliance with Internal standards and External regulations
  • Managing high-volume documentation and adhering to strict deadlines

Timeline

Credentialing Specialist II

Avesis, Incorporated
09.2023 - 01.2025

Independent Contractor

Various Companies
06.2016 - Current

Medical Staff Credentialing Coordinator

Baltimore Medical System, Inc
06.2015 - 05.2018

Health System Credentialing Coordinator

Sheppard Pratt Health System
11.2014 - 06.2015

Patient Care Coordinator

Home Physicians, Chesapeake
08.2012 - 01.2013

Inpatient Financial Counselor

Northwest Hospital
02.2012 - 08.2012

Credentialing Coordinator

Superior Vision
01.2012 - 11.2014

Patient Service Coordinator

Central Maryland Urology Associates
03.2011 - 01.2012

Executive Administrative Assistant

Beco Management, Inc
06.2007 - 12.2011

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Seton Keough High School

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