MARY CAROL MICHAUD
Henderson,NV
Summary
Experienced and detail-oriented Credentialing Specialist with over 10 years of expertise in medical credentialing, contracting, and billing management. Adept at managing the credentialing process for healthcare providers, ensuring compliance with industry standards and regulations. Proven track record of optimizing workflows, reducing processing times, and enhancing overall operational efficiency. With 5 years of experience working remotely, I am highly skilled in managing tasks independently, utilizing digital tools, and maintaining effective communication across virtual teams. Seeking a remote Credentialing Specialist position to apply my extensive background and contribute to the success of a dynamic healthcare organization.
Overview
10
10
years of professional experience
1
1
Certificate
Work History
Credentialing and Contracting Specialist-Remote
Mary Carol Credentialing and Consulting
Henderson, NV
05.2020 - Current
- Provided guidance and assistance regarding initial contracting and credentialing processes for new provider groups within the Southern Nevada area.
- Negotiated initial contracts for newly established provider groups with different specialties.
- Analyzed local market trends in order to determine appropriate pricing strategies when negotiating contracts.
- Drafted requests for proposals based on provider requirements.
- Successfully credentialed provider groups with government-based and commercial insurances.
- Established positive relationships with provider insurance credentialing and contracting representatives, and medical staff service departments within the Southern Nevada area.
- Researched and collected data of external markets for providers who were interested in practicing outside the state of Nevada.
Lead Credentialing/Contracting Specialist-Hybrid
Kidney Specialists of Southern Nevada
Las Vegas, NV
10.2019 - Current
- Developed and implemented departmental credentialing procedures, increasing provider enrollment application turn-around time by 70%.
- Performed quarterly audits of provider and facility credentialing files to maintain compliance with applicable state and national regulations and policies.
- Developed and implemented audit procedures for biannual payer contract reviews for medical group and ASC locations.
- Monitored payer payments with the billing department to ensure reimbursement is within contractual obligations.
- Successfully established new payer contracts for the medical group and an ASC location, increasing patient volume by 30% for the organization.
- Established and maintained relationships with multiple payer representatives and medical staff service directors to ensure constant communication between both parties.
- Ensured timely completion of credentialing processes by providing guidance to providers on required documentation for payer and hospital credentialing.
Credentialing/Contracting Specialist Lead-Hybrid
Hometown Health
Las Vegas, NV
02.2018 - 10.2019
- Performed initial review of new providers and medical groups to determine eligibility for enrollment into the network.
- Validated primary source documents, such as state licenses, diplomas, certifications, and other related credentials, utilizing various resources, including state licensing board websites and other URAC-approved verification board websites.
- Actively participated in special contracting projects or initiatives pertaining to improvement of operational efficiency within the department.
- Provided guidance and support regarding credentialing and contracting processes, policies, and procedures to internal staff members as needed.
- Participated in meetings with physicians and medical provider groups in order to negotiate favorable terms for both parties.
- Maintained positive working relationship with fellow staff and management.
- Provided updates on the status of contract and credentialing processes to upper management and provider groups.
Credentialing/Medical Billing Manager- Onsite
Surgical Dermatology and Laser Center
Las Vegas, NV
04.2015 - 01.2018
- Implemented strategic analysis techniques to identify and address delinquent patient accounts, leading to a decrease in unpaid accounts and decreasing patient AR accounts by 50%.
- Streamlined claims denial processes and implemented effective tracking systems to meet the company's quarterly billing targets.
- Developed and implemented onboarding credentialing processes for new providers.
- Reviewed and processed credentialing applications to ensure accuracy, completeness, and compliance with all accreditation standards.
- Negotiated terms and conditions of new contracts on behalf of the company.
- Resolved any discrepancies between contract requirements and actual performance or services rendered.
- Actively reviewed payer fee schedules to ensure the group was receiving proper reimbursement for services rendered.
Education
Bachelor of Science - Business Administration
Post University
01.2018
Skills
- NCQA/URAC/TJC proficient
- Knowledge in regulatory and accreditation standards, legal principles of credentialing and contracting, heath care definitions, and medical terminology
- Proficient in Microsoft office applications (Word, Excel, PowerPoint, and Outlook)
- Proven success in establishing and maintaining relationships with providers, payers and hospitals
- Teamwork and collaboration
- Contract negotiation
- Analytical decision making
- Efficient communicator
Affiliations
- President of Nevada NvAMSS chapter
Accomplishments
- Recipient of 2020 Resilience award from Kidney Specialists of Southern Nevada
- Recipient of 2024 NAMSS Empowering Tomorrow's MSP Scholarship.
Certification
- Provider Enrollment Specialist (PECS)- Certified in Medicare provider enrollment and billing
Timeline
Credentialing and Contracting Specialist-Remote
Mary Carol Credentialing and Consulting
05.2020 - Current
Lead Credentialing/Contracting Specialist-Hybrid
Kidney Specialists of Southern Nevada
10.2019 - Current
Credentialing/Contracting Specialist Lead-Hybrid
Hometown Health
02.2018 - 10.2019
Credentialing/Medical Billing Manager- Onsite
Surgical Dermatology and Laser Center
04.2015 - 01.2018
Bachelor of Science - Business Administration
Post University
- Provider Enrollment Specialist (PECS)- Certified in Medicare provider enrollment and billing
References
References available upon request.
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