Summary
Overview
Work History
Education
Skills
Timeline
Generic

Sheena Worsham

Operations Leader
Austin

Summary

Results-driven Operations Leader with over a decade of progressive experience in healthcare credentialing, compliance, and outsourced vendor management. Skilled in designing and scaling credentialing operations to meet strategic growth objectives, regulatory requirements, and staffing needs. Proven track record of leading high-performing teams, implementing process automation, and achieving significant improvements in efficiency, compliance, and cost management. Extensive background in managing both in-house and BPO operations, spearheading cross-functional projects, and aligning credentialing processes with organizational priorities. Dedicated to operational excellence, continuous enhancement, and establishing scalable, audit-ready systems within dynamic healthcare settings.

Overview

14
14
years of professional experience
6
6
years of post-secondary education

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 from the ground up, creating and operationalizing credentialing policies and procedures tailored to a telemedicine startup environment.
  • Designed frameworks, processes, and workflows for the initial credentialing and recredentialing of Physicians, Advanced Practice Providers, and Allied Health Professionals.
  • Oversaw and managed relationships with Credential Verification Organizations (CVOs), ensuring effective collaboration and service delivery.
  • Recruited, trained, and supervised credentialing staff, providing coaching and performance evaluations to maintain high productivity and adherence to internal procedures.
  • Monitored and reported turnaround times for processing credentialing applications, focusing on quality and efficiency.
  • Coordinated the renewal process to ensure all clinical provider licenses and certificates remained current, with proactive notifications prior to expiration.
  • Prepared for and coordinated credentialing audits in compliance with managed care delegated credentialing contracts.
  • NCQA standards, developed criteria to ensure adherence, and revised credentialing and privileging processes as necessary.
  • Prepared and presented provider files to the Credentialing Committee for review and approval.
  • Led the assessment and implementation of the MDStaff credentialing database, enhancing data management capabilities.
  • Initiated and conducted NCQA accreditation gap analysis to ensure readiness for initial surveys.
  • Managed special projects and new initiatives related to credentialing, contributing to continuous improvement.

Sr. Medical Staff Credentialing Manager

University of Texas Health Science Centers (UT Physicians)
04.2017 - 03.2020
  • Initiate and coordinates 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

No Degree - Early Childhood Education

Prairie View A&M University
Prairie View, TX
05.2003 - 05.2006

High School -

George Ball High School
Galveston, TX
08.1999 - 05.2002

Skills

  • Operational strategy development
  • Process improvement
  • Cost management
  • Healthcare credentialing oversight
  • Proficient in NCQA compliance standards
  • CMS
  • Experience with Joint Commission compliance
  • Vendor relationship oversight
  • Team leadership
  • Interdepartmental teamwork
  • Proficient in MS Office Suite
  • G Suite proficiency
  • Experienced with project management tools
  • Trello project management
  • Performance metrics analysis
  • Tableau data visualization

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

No Degree - Early Childhood Education

Prairie View A&M University
05.2003 - 05.2006

High School -

George Ball High School
08.1999 - 05.2002

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