Mary Jane Johnson
Converse,TX
Summary
Dynamic Credentialing Coordinator with extensive experience at Baptist Health System, excelling in regulatory compliance and data verification. Proven ability to enhance provider support and streamline credentialing processes, ensuring adherence to standards. Strong organizational skills and a commitment to customer service excellence drive successful outcomes in high-pressure environments.
Overview
13
13
years of professional experience
Work History
Credentialing Coor.
Baptist Health System
San Antonio, TX
03.2023 - 03.2025
- Maintained accurate records through meticulous data entry for applications.
- Facilitated communication by managing inbound and outbound calls with provider contacts.
- Tracked expirables while processing initial appointments and re-appointments efficiently.
- Organized documentation through effective document scanning practices.
- Verified credentials of healthcare professionals through primary source checks.
- Monitored compliance and updated tracking logs systematically in spreadsheets.
- Delivered regular status updates to leadership, supporting decision-making processes.
- Ensured adherence to regulatory standards for healthcare professional qualifications.
Credentialing Specialist
UT Health Science Center
10.2022 - 02.2023
- Check for Accuracy
- Check for Consistency
- Check for completion
- Collects and records initial client information to include type of referral, type of insurance, and patient demographics
Credentialing Coor.
Aerotek Staffing/Baptist Health System
11.2021 - 09.2022
- Provide Support & serve as a liaison to Medical Staff/Allied Health Members & Officers
- Credential all Physicians & Allied Health Professionals (According JCAHO standards)
- Medical Staff Bylaws requirements
- Query- all state and/or federal agencies as part of credentialing process
- Maintain current Physician/Allied health roster
- Prepares & ensures compliance for all regulatory agencies
- Ensures data entry of all regulatory agencies
- Maintains a current physician and/or allied health roster
- Maintains and ensures that all necessary documents are current and on file (i.e. license, DEA, DPS, Malpractice)
- Provides secretarial support for All Medical Staff meetings as required
- Scanning
Credentialing Coor.
Pioneer Recruiting/Molina Healthcare of TX
03.2021 - 09.2021
- Electronically Receive TSCA/TAHP – scrubbing for accuracy, completeness
- Systems Used: Cactus, QNXT, CAQH, Availity, Access, PDL
- Responsible for Delegation, Credentialing, Term Mailbox
- Cactus (Software)
- Data Entry, Scanning documents, faxing documents
- Laserfiche (Electronic Filing Cabinet)
- Sharepoint Cred Request Submission Site; Updates, Address Move, Termination
Document Processor
T S R Consulting Service, Inc./Citigrp
04.2020 - 03.2021
- Portal/Citigroup/bank
- VMware Horizon
- Outlook
- Skype
- Spreadsheet
- Checks, Deposit Slips
- Ability to perform detailed billing and balance deposit slips
Remote Employee
Molina Healthcare of TX/Coordinator, Credentialing Specialist
11.2018 - 02.2020
- Maintaining computer and manual filing system
- Replying to emails and telephone calls
- Handle Multiple workloads and priorities
- Customer Service duties; Answer and return incoming credentialing calls with internal and external contacts
- Resolve problematic incoming calls
- Able to follow oral and written instructions
- Answering Emails in a timely manner, faxing and scanning documents
- Receiving, sort and distributing mail
- Managing multiple and changing priorities at once
- Attention to detail and accuracy
- MHT SiteVisit – Request
Engagement Employee Specialist/Credentialing Coor.
InGenesis Staffing Inc.
03.2018 - 10.2018
- Collection of all pertinent information necessary for verification of Physician & Allied Credentials through a variety of Primary sources as appropriate
- Scrub Provider files for completeness, accuracy, consistency, etc.
- Ensure files meet Joint Commission & other regulatory agency credentialing requirement & policies
- Upload data into the credentialing database
- Provide Information to department staff or individual physician as necessary by reporting from database system
- Communicate consistently with provider office staff to obtain & verify information & communicate
- Communicate Status of files with internal & external customers
- Serve as a resource to both healthcare Providers & Company staff regarding the credentialing process.
Remote employee
Molina Healthcare of Texas/ Coordinator, Credentialing Specialist
06.2009 - 11.2017
- Verify the credentials of the medical staff and the health-care facilities
- To ensure that the hospitals, medical staff, and the facilities comply with federal and state regulations.
- Process initial and Re-credentialing applications following departmental requirements and production goals.
- Credentialing and re-credentialing of all physicians and allied health practitioners
- Administrative and Clerical duties
- Licensure Verification per primary source
- Maintaining numerous physician information, data banks education, training, experience & licensure
- Maintaining an accredited continuing medical educ., (CME) program for Physicians to maintain clinical Competency
- ACGME – information regarding training institutions
- .JCAHO Regulations and Joint Commission Standards
- NCQA Regulations
- Joint Commission
- Querying EPSTAFF – OIG, NPDB
- CAQH online services that enable providers to complete just one standardize application
- Compiles & Maintains Current & accurate data for all providers in their CAQH accounts providers in
- And Facilitating meetings and communication between physician within & outside specialties
- Administrative duties such as filing, typing, copying, scanning etc.
- Handing sensitive information in a confidential manner
Customer Service Rep.
Snelling Staffing Agency/Customer Service Rep.
12.2008 - 05.2009
- Successfully handled high volume incoming calls in a timely manner.
- Utilizes multiple screens to gather information, conduct research, assess the situation, and enter data.
- Schedule Appointments – update database
- Complete initial data entry – create new files
- Ensures expedited requests are escalated and processed immediately.
Credentialing Specialist
Lockheed Martin/ Credentialing Specialist
04.2008 - 09.2008
- Responsible for MTF request electronically or on paper
- Facilities credentialing process including collecting the application and all required documents for review of completeness and forward to the Credentialing Department.
- Respond to Manager Request for Verification online or Verbal
- Communicate with Client, Credentialing Manager and Credentialing Specialist
- Communicate with Universities, Colleges and Military Facilities
- Data Entry and Scanning Documents into database
Verification Specialist
Bexar County Medical Society/Verification Specialist
04.2007 - 03.2008
- Responsible for Initial and Recred, Texas Standardized Applications from Hospital Clients
- Ensure that requirements are met through JCAHO standard
- Complete in a timely manner
- Research and conduct Verification online
- Communicate with Universities, Colleges and Previous employment
- Data Entry, Scanning and Facsimile
- Keeping daily log
- Communication with Provider, Credentialing Supervisor and Credentialing Specialist
- Prep Credentialing file for completion in a timely manner
Healthcare Finder
Humana, Tricare/Healthcare Finder
03.2006 - 04.2007
- Keyboard and other data entry device to enter data
- Received Referrals by mail or fax
- Outbound calling to hospitals for admission and discharge dates
- Plan and coordinate parts and work orders to the production floor.
Credentialing Coordinator
Humana, Inc/Credentialing Coordinator
01.2004 - 03.2006
- Responsible for research and preparing Texas Standardize Credentialing App for Review
- Communicate with Provider and Credentialing Manager
- Verification of Licensure, Education and previous employment – per NCQA cred standard
- Data Entry, facsimile and prep Credentialing File
Clerical/Credentialing Coordinator
Staffing Solutions Temp Agency/Clerical/Credentialing Coordinator
10.2002 - 01.2004
- Responsible for answering incoming calls, taking messages and typing basic memos
- Receptionist duties
- Customer Service duties
Cash Control Specialist
St Paul University Hospital Business Office/Dallas Tx/Cash Control Specialist
Dallas, Tx
06.2001 - 06.2002
- Received Explanation of Benefits (EOB)
- Daily balancing, resolving unidentified transaction
- Total all checks before posting
- Data Entry
- Successfully handled daily Cash Posting in a timely manner
Customer Service Rep.
Caremark Pharmaceutical/Customer Service Rep.
- Answered Customer’s telephone, inquires and concerning prescription(s) mail orders and insurance
- Policies
- Placing prescription orders
- Resolving complaints
- Explain policy of benefits and billing inquiries
Education
Diploma - Basic Curriculum
Edgewood H.S.
San Antonio, TX06-1986
non-degree - Business Administration and Management
St. Phillip’s College
San Antonio, TXSkills
- Managed care expertise
- Computer proficiency
- Microsoft Office applications
- Regulatory compliance
- Credentialing and re-credentialing
- Provider support
- Leadership communication
- Customer service excellence
- High-volume call handling
- Organizational skills
- Data verification
- Relationship building
- Communication skills
- Attention to detail
- Background checks
- Facility credentialing
- Software expertise
- License verifications
- Credentialing oversight and verification
- Time management abilities
- Administrative assistance
References
References Available Upon Request
Affiliations
- Volunteer at Nursing Facility
- Volunteer Secretary
- Volunteer Orginizer
Timeline
Credentialing Coor.
Baptist Health System
03.2023 - 03.2025
Credentialing Specialist
UT Health Science Center
10.2022 - 02.2023
Credentialing Coor.
Aerotek Staffing/Baptist Health System
11.2021 - 09.2022
Credentialing Coor.
Pioneer Recruiting/Molina Healthcare of TX
03.2021 - 09.2021
Document Processor
T S R Consulting Service, Inc./Citigrp
04.2020 - 03.2021
Remote Employee
Molina Healthcare of TX/Coordinator, Credentialing Specialist
11.2018 - 02.2020
Engagement Employee Specialist/Credentialing Coor.
InGenesis Staffing Inc.
03.2018 - 10.2018
Remote employee
Molina Healthcare of Texas/ Coordinator, Credentialing Specialist
06.2009 - 11.2017
Customer Service Rep.
Snelling Staffing Agency/Customer Service Rep.
12.2008 - 05.2009
Credentialing Specialist
Lockheed Martin/ Credentialing Specialist
04.2008 - 09.2008
Verification Specialist
Bexar County Medical Society/Verification Specialist
04.2007 - 03.2008
Healthcare Finder
Humana, Tricare/Healthcare Finder
03.2006 - 04.2007
Credentialing Coordinator
Humana, Inc/Credentialing Coordinator
01.2004 - 03.2006
Clerical/Credentialing Coordinator
Staffing Solutions Temp Agency/Clerical/Credentialing Coordinator
10.2002 - 01.2004
Cash Control Specialist
St Paul University Hospital Business Office/Dallas Tx/Cash Control Specialist
06.2001 - 06.2002
Customer Service Rep.
Caremark Pharmaceutical/Customer Service Rep.
Diploma - Basic Curriculum
Edgewood H.S.
non-degree - Business Administration and Management
St. Phillip’s College