Michele Lewitinn
Clifton Park,USA
Summary
A detail-oriented professional with over 15 years of progressive experience in the healthcare industry, specializing in the management of complex credentialing processes for facilities, provider groups, and individual professionals. Expertise in ensuring regulatory compliance with government and private insurance plans, utilizing credentialing software to enhance operational efficiency. Recognized for strong leadership and problem-solving skills that drive cost reduction and promote organizational effectiveness.
Overview
18
18
years of professional experience
Work History
Associate Director
Albany Med Health System
03.2024 - Current
- Assisted senior leadership in managing all aspects of operations.
- Led teams of up to 8 personnel, supervising daily performance as well as training and improvement plans.
- Provide operational leadership and support to internal teams for efficient problem identification and resolution.
- Manage and provide oversight for all provider application, recertification, and reinstatement processes.
- Fostered a culture of continuous improvement by encouraging staff to share innovative ideas and providing resources for professional development.
- Maintained compliance with industry regulations while adapting to changes in legislation or best practices as needed.
- Reviewed proposed regulatory changes and evaluated potential impacts on business operations.
- Maintained a thorough understanding of accreditation standards, enabling accurate interpretation of guidelines for staff members when needed.
- Evaluated employee performance and conveyed constructive feedback to improve skills.
- Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
- Prioritized tasks and allocated resources appropriately to keep teams focused and productive.
- Oversee all aspects of database management, including data integrity, reporting, and upgrade implementations.
- Reduced operational costs by identifying inefficiencies and implementing cost-saving measures in various departments.
Medical Staff Coordinator
Boston Medical Center - Brighton (Formally St. Elizabeth Medical Center)
09.2023 - Current
- Maintain and manage the credentialing database, ensuring accuracy and completeness of all practitioner information.
- Input practitioner data meticulously, enhancing the integrity and reliability of the credentialing system.
- Process initial credentialing applications for physicians and allied health professionals, ensuring adherence to compliance standards.
- Conduct primary source verification of licenses, certifications, education, and work history, utilizing online databases and direct correspondence.
- Maintained up-to-date knowledge of industry trends and regulations, ensuring the department''s continued compliance with changing requirements.
- Served as liaison between administration and clinical staff, fostering positive relationships and promoting open communication.
Senior Credentialing Specialist
Albany Med Health System
01.2022 - 03.2024
- Led the credentialing process for a provider network of over 3000 healthcare professionals, ensuring 100% compliance with regulations.
- Developed and implemented best practices for credentialing and privileging, in alignment with industry standards and regulatory requirements.
- Trained and mentored junior credentialing staff on new policies and procedures, enhancing team performance and reducing errors.
- Acted as a team lead to provide workflow support, manage network initiatives, and coordinate issue resolution with network staff.
- Maintain and manage the credentialing database, ensuring accuracy and completeness of all practitioner information.
- Input practitioner data meticulously, enhancing the integrity and reliability of the credentialing system.
- Process initial and re-credentialing applications for physicians, allied health professionals, and other providers, ensuring strict adherence to compliance standards.
- Conduct primary source verification of licenses, certifications, education, and work history, utilizing online databases and direct correspondence.
- Ensure that time is properly allocated to achieve credentialing deliverables and expectations of clients/physicians/providers, while adhering to credentialing standards.
- Ensures active communication with all external and internal constituencies to establish strong relationships that are complimentary and consistent with organizational goals and strategic needs.
- Assesses and re-prioritizes work in accordance with shifting priorities and backlog.
- Knowledge of related TJC, DNV, NCQA, and CMS standards.
- Prepare records for Certification Reviews / Managed Care Audits: TJC, DNV, AAAHC, NCQA, DOH, CMS, Managed Care Payors.
Credentialing Specialist
Albany Med Health System
07.2012 - 01.2022
- Maintain and manage the credentialing database, ensuring accuracy and completeness of all practitioner information.
- Process initial and re-credentialing applications for physicians, allied health professionals, and other providers, ensuring strict adherence to compliance standards.
- Maintained a thorough understanding of accreditation standards, enabling accurate interpretation of guidelines for staff members when needed.
- Conduct primary source verification of licenses, certifications, education, and work history, utilizing online databases and direct correspondence.
- Identifying and escalating red-flag issues.
- Organizing documentation for department and committee review and approval.
- Assisted in preparing for audits, resulting in successful accreditation and recognition for compliance excellence.
- Liaised with healthcare providers to address and resolve any credentialing issues promptly, maintaining strong professional relationships.
- Conducted audits of provider files, ensuring all necessary documents were up-to-date and compliant with regulatory requirements.
- Ensured compliance with industry standards by regularly updating policies and procedures related to credentialing.
- Assisted in training new employees on proper credentialing procedures, contributing to their rapid integration into the team environment.
Independent Contractor
Empire Health & Wellness Center
10.2017 - 06.2020
- Responsible for all aspects of the Medicaid, Medicare, and Commercial payer's credentialing and/or re-credentialing process.
- Recording and maintaining practitioner information in electronic and hard copy filing systems.
- Includes data entry and accurate maintenance of the credentialing database and safeguarding private and confidential information.
- Maintain Council for Affordable Quality Healthcare (CAQH) files for employed providers including reviewing, updating, and re-attesting to CAQH files every 120 days for each employed provider.
Computer Support Specialist
Kelly Services (NYS DOH Fee for Service)
02.2008 - 07.2012
- CAQH Applications
- Investigate provider's background to determine eligibility enrollment into the NYS Medicaid Fee for Service program.
- Ensure provider's files comply with federal and state regulations.
- Retrieving and creating provider files for other government agencies (FOIL Requests).
- Main phone line 3 days a week, answer provider questions, gather information and follow up as needed.
Education
Master of Science - Management
Southern New Hampshire University
Hooksett, NH07-2023
BBA - Business Administration
The Sage Colleges
Albany, NY08-2017
Associate in Occupational Studies - Business Management
Mildred Elley
Latham, NY09-2007
Skills
- Confidential document handling
- Experience in ensuring regulatory compliance
- Proficient in credentialing processes
- Credentialing policy development
- Database management expertise
- Proficient in Microsoft Office Suite
Timeline
Associate Director
Albany Med Health System
03.2024 - Current
Medical Staff Coordinator
Boston Medical Center - Brighton (Formally St. Elizabeth Medical Center)
09.2023 - Current
Senior Credentialing Specialist
Albany Med Health System
01.2022 - 03.2024
Independent Contractor
Empire Health & Wellness Center
10.2017 - 06.2020
Credentialing Specialist
Albany Med Health System
07.2012 - 01.2022
Computer Support Specialist
Kelly Services (NYS DOH Fee for Service)
02.2008 - 07.2012
Master of Science - Management
Southern New Hampshire University
BBA - Business Administration
The Sage Colleges
Associate in Occupational Studies - Business Management
Mildred Elley