Stephanie Powers
Millville,USA
Summary
Credentialing manager with strong focus on compliance, process optimization, and quality assurance. Demonstrates keen ability to lead, mentor, and collaborate with cross-functional teams to achieve organizational goals. Known for adaptability and reliability in managing credentialing workflows and ensuring regulatory adherence. Skilled in data management, communication, and problem-solving to drive results and enhance operational efficiency.
Overview
19
19
years of professional experience
Work History
Provider Enrollment & Credentialing Manager (Remote)
The Lactation Network
01.2024 - Current
- Built the credentialing department as well as policies and procedures from the ground up
- Led credentialing process improvements, enhancing efficiency and accuracy in provider onboarding.
- Developed and implemented training programs for staff on credentialing best practices and compliance standards.
- Managed relationships with key stakeholders, ensuring alignment on credentialing policies and procedures.
- Streamlined documentation processes, reducing turnaround time for provider applications by optimizing workflows.
- Oversaw quality control measures to ensure adherence to regulatory requirements within the credentialing department.
- Coordinated cross-departmental collaboration to enhance communication regarding credentialing updates and changes.
- Enhanced compliance with industry standards by conducting thorough audits of credential files.
- Ensured accuracy of provider data in internal databases through regular review and updates.
- Established strong relationships with external agencies, streamlining communication regarding provider credentials and facility statuses.
- Managed the onboarding process for new providers, ensuring timely completion of all required documentation.
- Led team meetings to discuss progress toward goals, troubleshoot issues, and share best practices among colleagues.
- Expedited the resolution of credentialing issues by liaising effectively with providers and external organizations.
- Maintained up-to-date knowledge of industry regulations, ensuring ongoing adherence to best practices in provider credentialing.
Provider Enrollment Manager
TeamHealth
Remote
02.2022 - 12.2023
- Analyzed enrollment data to identify trends, optimize processes, and improve overall efficiency.
- Trained and mentored staff on enrollment best practices and compliance regulations.
- Led initiatives to improve enrollment workflows, resulting in increased accuracy and reduced processing times.
- Facilitated communication between departments to ensure alignment on enrollment objectives and goals.
- Advised leadership on enrollment projections, providing data-driven insights for strategic planning and resource allocation decisions.
- Oversee credentialing processes to ensure compliance with regulatory standards.
- Develop and implement streamlined workflows for efficient credentialing operations.
- Train and mentor staff on best practices in credentialing management.
Contracting and Credentialing Consultant (Remote)
Actify Neurotherapies (TC MSO, INC)
02.2020 - 03.2020
- Led strategic initiatives to improve patient care protocols and enhance service delivery efficiency.
- Developed training materials to support staff onboarding and continuous education programs.
- Collaborated with cross-functional teams to streamline operational workflows and optimize resource allocation.
- Analyzed performance metrics to identify areas for process improvement and implement best practices.
- Spearheaded projects that enhanced organizational effectiveness and drove sustainable growth strategies.
Sr. Provider Enrollment Coordinator
TeamHealth
05.2015 - 01.2020
- Coordinated provider enrollment processes to ensure compliance with regulatory standards.
- Managed communication between providers and insurance companies to facilitate seamless enrollment.
- Streamlined documentation workflows to enhance efficiency in credentialing procedures.
- Implemented quality assurance measures to maintain accuracy in enrollment data management.
- Led initiatives to optimize provider enrollment timelines, reducing processing delays significantly.
- Mentored junior coordinators on best practices in provider enrollment and credentialing protocols.
- Established strong relationships with providers, fostering a positive rapport and ensuring long-term partnerships.
- Coordinated with cross-functional teams for seamless integration of new providers into existing systems.
- Assisted in reducing application processing time by efficiently reviewing and verifying provider credentials.
- Expedited the resolution of discrepancies or missing information through diligent follow-ups with providers or other stakeholders involved in the process.
- Maintained comprehensive records of enrolled providers, enabling easy access to information for internal stakeholders.
- Collaborated closely with billing departments to ensure accurate invoicing based on verified provider credentials and services rendered.
- Substantially reduced our provider hold report for NY from 4.9 million dollars to 33,000 dollars in one year through research and appeals
- Following strict guidelines for preparing enrollment applications in a consistent and accurate manner
- Developed, Perfected and implemented a new and efficient system when enrolling all providers with Medicare in Pecos
- Developed, Perfected and implemented a new and efficient system to maintain provider revalidation with our payers specifically Medicaid
Credentialing Dept Manager/ Provider Enrollment Dept. Manager/Surgical Dept. Manager/Contracting
Signature Smiles
05.2009 - 05.2015
- Oversaw daily operations, ensuring adherence to company policies and procedures.
- Developed and implemented credentialing policies to ensure compliance with industry regulations.
- Streamlined the credentialing process, reducing turnaround time for provider applications.
- Led cross-functional teams to enhance operational workflows in credentialing practices.
- Trained and mentored staff on best practices in credentialing and quality assurance measures.
- Developed training programs for staff, enhancing team performance and service quality.
- Implemented process improvements, reducing wait times and increasing patient satisfaction.
- Led cross-functional teams in strategic planning sessions to align departmental goals with company vision.
- Analyzed performance metrics, identifying trends to inform decision-making and operational adjustments.
- Fostered a collaborative work environment, mentoring employees to enhance skill development and retention.
- Coordinated patient care initiatives, streamlining workflows to improve overall service delivery efficiency.
- Established clear performance expectations for staff members which led to increased accountability.
- Evaluated employee performance fairly and accurately, rewarding hard work while addressing areas needing improvement.
Medical Receptionist
HOLLY CITY PEDIATRICS
08.2007 - 05.2009
- Managed patient check-ins and appointment scheduling to ensure efficient office operations.
- Coordinated communication between healthcare providers, patients, and families to enhance service delivery.
- Checked patient insurance, demographic, and health history to keep information current.
- Maintained strict confidentiality of patient information, adhering to HIPAA regulations and medical office policies.
- Processed insurance claims and verified patient eligibility to streamline billing procedures.
- Maintained accurate electronic health records, ensuring data integrity and compliance with privacy regulations.
Education
High School Diploma -
Lower Cape May Regional High School
Cape May NJ06-1995
Skills
- Provider enrollment
- Credentialing
- Management
- NCQA Standards
- Application processing
- Documentation review
- Credentialing compliance
- Delegated Credentialing
- Data management
- Data Integrity
- License monitoring
- Credential verification
- CAQH Expert
- NPPES Expert
- PECOS Expert
- CMS Expert
- Availity
Timeline
Provider Enrollment & Credentialing Manager (Remote)
The Lactation Network
01.2024 - Current
Provider Enrollment Manager
TeamHealth
02.2022 - 12.2023
Contracting and Credentialing Consultant (Remote)
Actify Neurotherapies (TC MSO, INC)
02.2020 - 03.2020
Sr. Provider Enrollment Coordinator
TeamHealth
05.2015 - 01.2020
Credentialing Dept Manager/ Provider Enrollment Dept. Manager/Surgical Dept. Manager/Contracting
Signature Smiles
05.2009 - 05.2015
Medical Receptionist
HOLLY CITY PEDIATRICS
08.2007 - 05.2009
High School Diploma -
Lower Cape May Regional High School