Summary
Overview
Work History
Education
Certification
Timeline
Generic

Nelda Norris

Lanham,MD

Summary

Talented Team Leader experienced and dedicated to enhancing employee satisfaction and business success. Diplomatic and friendly with proven commitment to employee training. Hardworking team player bringing necessary experience and knowledge to tackle any operational demand.

Overview

20
20
years of professional experience
1
1
Certification

Work History

Lead

  • Coordinated, and monitored the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility
  • Conducted thorough background investigation, research, and primary source verification of all components of the application file
  • Identified issues that required additional investigation and evaluation, validates discrepancies, and ensures appropriate follow up
  • Prepared credentialing files for completion and presentation to Health System Entity Medical Staff Committees, ensuring file completion within specified times
  • Processed requests for privileges, ensuring compliance based on clinical privilege policies
  • Responded to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise
  • Utilized credentialing database, optimizing efficiency, and performs query, report, and document generation; submit and retrieve National Practitioner Database reports in accordance with Health Care Quality Improvement Act
  • Monitored the initial, reappointment and expire process for all medical staff, ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state), as well as Medical Staff Bylaws, Rules and Regulations, policies and procedures, and delegated contracts.

hUMAN RESOURCES Assistant MANAGER

Planned parenthood
09.2019 - Current
  • Manage and maintain organization job descriptions and position requirements
  • Organize and conduct new hire orientation and training
  • Collaborate with internal and external stakeholders
  • Process new hire set-ups, terminations, and changes in a timely fashion
  • Proactively audit and review employee compensation to ensure accuracy in payroll
  • Assist employees with payroll policies, procedures, and regulations
  • Proactive liaison between medical plans and employees
  • Submit and review for accuracy FMLA paperwork to the short-term benefits vendor
  • Submit and review for accuracy paperwork to the office of workers compensation.

cREDENTIALING SPECIALIST

PLANNED PARENTHOOD
05.2018 - 09.2019
  • Obtain doctor documentation and data to setup electronic files
  • Completed in-depth review and analysis of each Medicaid application and accompanying documentation to ensure providers meet health plan guidelines and eligibility
  • Monitor credentials pending expiration, including health plan recredentialing
  • Run weekly audit reports to follow up on pending applications
  • Manage doctor malpractice insurance
  • Utilize and apply knowledge of regulatory and accreditation requirements (NCQA, CMS, URAC, Medicaid)
  • Support revenue cycle division: Billing, Collections, and Verification operations
  • Collaborate with health insurance plans to improve doctor enrollment and contract opportunities.

Provider enrollment analyst

HOSPITAL
05.2016 - 11.2016
  • Accurately processed provider notices from Managed Care Organizations
  • Verify system is appropriately set up for billing
  • Analyzed tracking report to monitor new physician enrollment
  • Followed up and resolved payer issues as guided by the expected payer enrollment
  • Provided ongoing technical assistance to the payer, provider enrollment departments
  • Tracked documents to resolve missing data or expired enrollment
  • Communicated non-compliance matters with Medical Staff Office and senior management.

CREDENTIALING COORDINATOR

REEF SYSTEM
06.2015 - 05.2016

CREDENTIALING analyst

CAREFIRST BCBS
02.2003 - 10.2014
  • Entered contracted providers demographic information into system for efficient billing
  • Completed and maintained special projects as needed
  • Run weekly CAQH Reports
  • Assisted Credentialing staff with questions and daily concerns
  • Accurately credentialed files while ensuring the provider meets state and federal guidelines
  • Ensured Credentialing department policies and procedures are being met daily
  • Analyzed and researched provider applications and credentials for provider eligibility to network
  • Quality audited files to ensure NCQA guidelines
  • Determined contract type based on specialty and fees
  • Reviewed and determined acceptance of contracts
  • Fully executed contracts that were received after approval
  • Review doctor clinical and professional history to accurately submit a Credentialing Committee Report.

Education

BA - Technical Management/Health Services Management

Devry university

Business Management

uNIVERSITY OF PHOENIX
2015

Certification

Human Resources/Management Payroll processing Performance Management Benefits Administrator Worker’s Compensation 30 + Years in Customer Relations New Hire Training Onboarding Teamwork collaboration Family Medical Leave Act (FMLA)

Timeline

hUMAN RESOURCES Assistant MANAGER

Planned parenthood
09.2019 - Current

cREDENTIALING SPECIALIST

PLANNED PARENTHOOD
05.2018 - 09.2019

Provider enrollment analyst

HOSPITAL
05.2016 - 11.2016

CREDENTIALING COORDINATOR

REEF SYSTEM
06.2015 - 05.2016

CREDENTIALING analyst

CAREFIRST BCBS
02.2003 - 10.2014

Lead

BA - Technical Management/Health Services Management

Devry university

Business Management

uNIVERSITY OF PHOENIX
Human Resources/Management Payroll processing Performance Management Benefits Administrator Worker’s Compensation 30 + Years in Customer Relations New Hire Training Onboarding Teamwork collaboration Family Medical Leave Act (FMLA)

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Nelda Norris