Summary
Overview
Work History
Education
Skills
References
Timeline
Generic

Sheena Worsham

Austin,TX

Summary

Dynamic and results-driven Operations with over a decade of progressive leadership in healthcare credentialing, compliance, and outsourced vendor management. Proven ability to design and scale credentialing operations that align with strategic growth, regulatory demands, and workforce deployment goals. Adept at leading high-performing teams, driving process automation, and delivering measurable improvements in efficiency, compliance, and cost control. Experienced in managing both in-house and BPO operations, leading cross-functional initiatives, and aligning credentialing workflows with enterprise-wide priorities. Committed to operational excellence, continuous improvement, and building scalable, audit-ready systems in fast-paced healthcare environments.

Overview

14
14
years of professional experience

Work History

Director of Operations, Credentialing

ShiftMed, LLC
08.2022 - Current
  • Oversaw end-to-end credentialing operations for 40,000+ healthcare professionals annually, ensuring 100% compliance with state, federal, and industry regulations.
  • Designed and launched standardized credentialing workflows that reduced average onboarding time by 38%, accelerating field deployment across 35+ markets.
  • Built and led a team of 20+ credentialing specialists, improving team productivity by 45% through targeted training, process alignment, and performance management.
  • Negotiated and managed contracts with 2 global BPO vendors, resulting in $500K+ in annual cost savings and a 20% improvement in SLA adherence.
  • Spearheaded automation of key credentialing tasks, cutting manual processing by 60% and reducing error rates by 35%.
  • Conducted detailed workflow analysis across credentialing systems; implemented a centralized credentialing database that increased process visibility by 50%.
  • Developed and executed a department-wide cost optimization strategy that reduced operational spend by 18% without compromising quality or compliance.
  • Partnered with cross-functional teams (IT, HR, Compliance, Legal) to align credentialing with onboarding strategy, improving time-to-credential by 30%.
  • Achieved 100% audit readiness and full compliance in NCQA, CMS, and Joint Commission credentialing reviews over a 3-year period.
  • Implemented career development plans and mentoring programs, increasing team engagement scores by 22% and internal promotion rate by 40%.

Medical Staff Credentialing Manager

Babylon Health
03.2020 - 07.2022
  • Built the Medical Staff Credentialing department by creating and operationalizing Credentialing Policies & Procedures in a startup Telemedicine environment.
  • Developed framework, processes and workflows for Physicians, Advanced Practice Providers & Allied Health Professionals for initial and recredentialing.
  • Oversight and vendor management with the CVO by developing and maintaining a positive working relationship.
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.
  • Oversees day to day work allocation, enforcement of internal procedures and controls, and problem resolution; motivates employees to achieve peak productivity and performance.
  • Monitors and reports turnaround times for processing of credentialing applications, with continued focus on delivery of a high quality and efficiency.
  • Coordinates the management of the renewal process to ensure all clinical provider licenses and certificates remain current, ensuring appropriate notification prior to expiration.
  • Prepares for and coordinates credentialing audits in compliance with the managed care delegated credentialing contracts.
  • Analyze NCQA standards and develops criteria to ensure adherence; revises general aspects of credentialing and privileging process as necessary; makes recommendations for and implements changes in policies and procedures.
  • Prepares and presents provider files to the Credentialing Committee for review.
  • Lead assessment process for a credentialing database & implementation of MDStaff.
  • Initiated & performed NCQA accreditation gap analysis for initial survey readiness.
  • Responsible for special projects and new initiatives related to credentialing, as needed.

Sr. Medical Staff Credentialing Manager

University of Texas Health Science Centers (UT Physicians)
04.2017 - 03.2020
  • Initiate and coordinate the credentialing process for all onboarding OBGYN medical staff including Physicians, PAs, NPs, Research Nurses, Genetic Counselors, Sonographers and Dieticians initial applications, and specific privileges in accordance with Medicaid, CMS Conditions of participation, Bylaws, Rules & Regulations and Medical Staff Requirements of UT contracted hospitals.
  • Assist new physicians as needed with applying for TX medical licensure, NPI numbers and DEA certifications.
  • Oversees a continuous credentialing process for over 200 providers by obtaining and reviewing all documents required for providers credentialing files; and ensures all information is provided to perform primary source verifications of medical malpractice insurance, licenses, prescriptive licenses, and other required certifications for membership and reappointment.
  • Maintains confidential, accurate, and up to date files for the medical staff and Allied Health Professionals that may include credentialing, reappointments, and other pertinent information. Conducts internal file audits to ensure accuracy and efficiency throughout the credentialing process.

Credentialing Manager

Amerigroup Corporation (Anthem)
05.2011 - 03.2017
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.
  • Coordinates daily workflow of the department and credentialing workflow.
  • Oversees new and existing employee training, in alignment with standard operating procedures of the department.
  • Promotes individual professional growth and development by meeting requirements for continuing education and skills competency.
  • Coordinates special projects related to Credentialing activities.
  • Resolves issues and complaints related to provider credentialing and enrollment.
  • Provided Texas statewide credentialing support to maintain enterprise-wide compliance and consistency.
  • Manages the development, implementation, and control of the credentialing process for all in-house professional provider consultants and all contracted providers.
  • Ensures accurate and timely information for initial and re-credentialing, data analysis and directory generation.
  • Ensures that all legal, licensure and accreditation standards are met.
  • Oversees the development, implementation, and control of the credentialing process. Provides guidance on credentialing policies, procedures, NCQA accreditation and regulatory requirements.
  • Reviews the approval and termination of practitioner, ancillary, facility, and long-term care providers as they relate to the credentialing process.
  • Recommends changes to credentialing criteria and processes.
  • Responsible for special projects and enterprise initiatives.
  • Ensures credentialing activities are integrated within the appropriate QI committees and departments.
  • Prepares for and attends Credentials, Medical Executive Committee Meetings.

Education

High School Diploma -

George Ball High School
Galveston, TX
05.2002

Prairie View A&M University
Prairie View, TX

Skills

  • Operational Strategy & Execution
  • Operational efficiency
  • Operations oversight
  • Workflow Optimization
  • Cost Reduction & Risk Mitigation
  • BPO & Vendor Management
  • KPI tracking
  • Healthcare Credentialing Compliance
  • NCQA, CMS, Joint Commission Standards
  • Team Leadership & Development
  • Cross-Functional Collaboration
  • MS Office Suite
  • G Suite
  • Project Management Tools: Monday Com, Trello
  • Performance Dashboards; Tableau

References

References available upon Request

Timeline

Director of Operations, Credentialing

ShiftMed, LLC
08.2022 - Current

Medical Staff Credentialing Manager

Babylon Health
03.2020 - 07.2022

Sr. Medical Staff Credentialing Manager

University of Texas Health Science Centers (UT Physicians)
04.2017 - 03.2020

Credentialing Manager

Amerigroup Corporation (Anthem)
05.2011 - 03.2017

High School Diploma -

George Ball High School

Prairie View A&M University

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