Nicole Metrusias
John D. Dingell VAMC
Davison,MI
11
years of professional experience
Credentialing & Privileging Assistant Manager (Supervisory) with responsibility for auditing 25–49 provider credential files per month, completing 15–29 FPPE and OPPE compliance reviews per month, and second-level review of privileging files. Leads 1–2 office specialists, supports compliance with VHA and TJC standards, and partners with medical center leadership to resolve discrepancies, strengthen workflow, and keep credentialing actions timely and accurate. Serves as the primary consultant for the facility’s Credentialing and Privileging program when the manager is absent.
Work History
Credentialing & Privileging Assistant Manager (Supervisory)
3 Years 6 Months- Hours per week: 40
- Conducts audits of provider credentials, such as licenses, provider certifications and ensures that detailed information is documented on provider exit review forms, privileging documents, FPPE and OPPE tracking system, credentialing program training requirements and Committee recommend actions.
- Analyze and interpret complex credentialing & privileging data to identify discrepancies, assess compliance, and support accurate and timely credentialing decisions.
- Prepares and analyzes reports and data and clearly communicates findings and results.
- Prepares and analyzes reports and data and clearly communicates findings and results.
- Assists the Credentialing and Privileging Manager with oversight of all functions related to healthcare providers’ professional credentials supporting all divisions of the Medical Center.
- Working collaboratively with local and VISN leadership to identify and/or implement best practices and advise Medical Center leadership of all program requirements pertaining to the Credentialing and Privileging program in collaboration with the Credentialing and Privileging Manager.
- Analyze credentialing metrics and reports to identify trends, monitor processing timelines, and support process improvement initiatives.
- Ensure quality assurance and assist the Credentialing and Privileging Manager with providing oversight for the Medical Center Credentialing and Privileging program.
- Assisted Manager in outlining VAMC Credentialing and Privileging Program goals and objectives, identified risks, supervised Credentialing and Privileging office specialists, ensured training and education, and completed second level reviews.
- Provided technical and administrative supervision to subordinate employees in VAMC Credentialing and Privileging Office, fostering team development and ensuring compliance.
- Identifies and presents to leadership the resources necessary for accomplishing the mission and function of the facility’s Credentialing and Privileging program.
- Identifies developmental and training needs of employees.
- In the absence of the C&P Manager, serves as the primary consultant for the facility’s Credentialing and Privileging program.
- Applies organizational and system-wide strategies for continuous quality improvement as they relate to Credentialing and Privileging processes and procedures.
- Implemented mechanisms to monitor and evaluate task compliance with established policies and procedures, enhancing quality of customer service.
- Assists with developing, coordinating, and recommending changes for the improvement of workflow in the program or section area.
- Executed various job duties to support departmental functions.
- John D. Dingell VAMC | Detroit, MI
- Developed and implemented training programs for new staff, enhancing team performance and service delivery.
- Mentored junior staff members, providing guidance on best practices in patient management and operational procedures.
- Supervised day-to-day operations to meet performance, quality and service expectations.
- Promoted teamwork within the workplace by encouraging collaboration among staff members on various project tasks.
Credentialing & Privileging Specialist
4 Years 8 Months- Reviewed correspondences between local and VISN leadership to ensure clear communication and alignment on credentialing processes
- Provides guidance and instruction to hospital staff in completing the required documentation of establishing privileges for LIPs
- Ensures primary source verification to include state licenses, DEA license, certifications, medical specialty and board certifications
- Ensures application packages and other documents meet technical requirements per specialty of provider and assures application folder and database account meet technical requirements
- Guided hospital staff in completing required documentation for establishing privileges for LIPs, improving accuracy and compliance with credentialing standards
- Responsible to ensure LIPs credential files are prepared properly, maintained appropriately, accurate and current
- Ensures current information is present on providers relative to state licensure, DEA, NPDB enrollments and renewals, FSMB, documentation of professional education, specialty medical training, certifications, adverse license or privileging actions, initial and renewal of privileges
- Conducts final appointment into the VetPro database, after thoroughly researching, analyzing and validating all data, information, documents and signature authorities
- Receives and reviews VetPro reports detecting problem areas requiring further investigation, serious issues are elevated to the supervisor
- Receives and reviews correspondences between local and VISN leadership
- Conducted final appointments in VetPro database, validating all data and documents to ensure integrity and compliance in the credentialing process
- Ensures accurate provider data is entered into and maintained in VetPro Offers guidance and insight to employees regarding work and administrative matters
- Served as TMS Local Unit Coordinator, assisting providers with concerns and escalating issues to IT Operations.
- Hours per week: 40
- Coordinated training sessions for staff on best practices in patient management and safety protocols.
- Facilitated multidisciplinary meetings to align team objectives with organizational goals and improve care delivery.
- Implemented new training programs for staff, leading to higher employee retention rates and better overall performance.
- Developed training materials to enhance staff proficiency and productivity.
Medical Support Assistant
2 Years 8 Months- Established effective communication skills and collaborated with medical center teams, clinics, programs, and services to enhance patient support.
- Establishes excellent communication skills and work collectively with medical center teams, clinics, programs, services and team members
- Comprehension and skill of the hospital computer system to complex clinic scheduling information and general patient information used to help in patient's telephone calls
- Maintain current knowledge and answer questions of other workers on procedures, policies, orders, etc. and get needed information or decisions from supervisor on problems that come up
- Answering incoming calls, greeting the callers in a polite tone and responding to their requests or queries
- References available upon request
- Facilitated patient scheduling and managed appointment logistics to enhance clinic efficiency.
- Coordinated communication between medical staff and patients, improving service delivery and satisfaction.
- Assisted in maintaining electronic health records, ensuring accuracy and compliance with regulations.
- Developed training materials for new hires, promoting consistency in service and adherence to protocols.
- Maintained a high degree of professionalism and composure in high-stress situations, ensuring the well-being of patients and staff alike.
Skills
Privileging review
Application file review
Provider enrollment
Medical staff services
Initial appointment processing
Reappointment processing
Credential file maintenance
Regulatory compliance
TJC standards
Supervisory oversight
FPPE/OPPE tracking
Committee support
Leadership reporting
Staff training
Process improvement
Timeline
Credentialing & Privileging Assistant Manager (Supervisory)
John D. Dingell VAMC
02.2023 - CurrentRead More
Credentialing & Privileging Specialist
John D. Dingell VAMC
06.2018 - 02.2023Read More
Medical Support Assistant
John D. Dingell VAMC
10.2015 - 06.2018Read More