Susan Porter
Antioch,TN
Summary
Results-driven Manager experienced in database management and leadership within credentialing operations. Achieved enhanced compliance and efficiency through strategic process improvements and employee development initiatives. Focused on fostering team engagement and performance, leveraging strong problem-solving skills and a comprehensive understanding of policies and procedures.
Overview
4
4
years of post-secondary education
21
21
years of professional experience
Work History
Manager, Credentialing & Licensing
PopHealthcare/Emcara
04.2023 - Current
- Managed all Credentialing functions, including application management and primary source verification, ensuring adherence to standards.
- Oversaw operations of Credentialing Department, developing and managing processes for Credentialing, Re-Credentialing, Expirable Data Management, and Delegated Credentialing Contracts.
- Supervised Credentialing Staff in daily management of credentialing process and database, optimizing workflow and accuracy.
- Maintained compliance with the appropriate accrediting and regulatory agencies.
Manager, Payer Enrollment
Privia Health
10.2021 - 04.2023
- Facilitated enrollment program as primary liaison for clinics, payers, billing office, and practitioners. Managed communication and issue resolution.
- Facilitated the enrollment program and served as the primary enrollment liaison for clinics, payers, billing office, and practitioner related issues.
- Assured compliance with health plan requirements related to provider certification and credentialing.
- Developed auditing and reporting tools and procedures to streamline credentialing processes and enhance communication with stakeholders.
- Managed daily enrollment processes of Payer Enrollment staff, overseeing operations and ensuring compliance with health plan requirements.
Director, Credentialing
Upperline Health
10.2019 - 10.2021
- Established leadership structure, policies, and procedures for Credentialing and Enrollment Staff, ensuring effective departmental oversight.
- Provided weekly operations and quality reporting, while identifying improvement opportunities which enhanced the operations and provider experience.
- Managed relationships with health plan and EMR vendors to facilitate seamless operations.
- Trained Practice Managers on EMR tasks, overseeing complex departmental task completion to enhance operational effectiveness.
Supervisor, Provider Credentialing & Enrollment
PopHealthcare
04.2018 - 10.2021
- Assisted in building health plan relationships and managing network personnel, overseeing processes for credentialing, provider enrollment, and delegated credentialing agreements.
- Supervised credentialing staff in daily management of credentialing process and database, ensuring accuracy and timeliness.
- Ensured staff met compliance guidelines, maintaining adherence to regulatory standards.
Managed Care Credentialing Specialist
Brookdale Senior Living, Inc.
03.2015 - 04.2018
- Coordinated and maintained credentialing and re-credentialing processes for senior living facilities, ensuring compliance with managed care and Medicaid payer requirements.
- Monitored and resolved regulatory and compliance issues, safeguarding operational integrity and adherence to industry standards.
- Developed credentialing and contract analysis report for senior leadership, providing insights for strategic decision-making.
- Identified and addressed regulatory and compliance issues.
- Facilitated onboarding for new associates to ensure they were equipped with essential skills and knowledge.
Senior Credentialing Specialist
UnitedHealth Group
01.2013 - 03.2015
- Led the External Credentialing Team.
- Oversaw Physician, NP, & RN payer credentialing and re-credentialing processes, managing team administrative tasks for efficiency.
- Facilitated credentialing committee meetings to track progress and decisions.
- Effectively trained new team members and market level staff on Credentialing guidelines, regulations, processes and compliance issues.
- Created and distributed monthly Credentialing activity reports for Senior Management, in addition to performing monthly file audits on team members.
- Performed Provider Onboarding process, contract analysis, and rate re-negotiations.
Credentialing Specialist
Radiology Alliance, PC
09.2011 - 12.2012
- Acquired and sustained TriStar Health hospital privileges and health plan memberships for the Physician Group Members.
- Resolved enrollment issues concerning claims payment.
- Maintained comprehensive CME files, Modality Case Logs, Nuclear Licenses, Immunization Files, and Sedations Tests, supporting credentialing and compliance for Physician Group Members.
- Managed CME files, Modality Case Logs, Nuclear Licenses, Immunization Files, and Sedations Tests for Physician Group Members.
- Obtained security access to TriStar Health Hospitals for all Group Members. to TriStar Health Hospitals for all Group Members.
Provider Enrollment Coordinator
CogentHMG
12.2010 - 08.2011
- Coordinated completion and submission of Provider Enrollment applications to governmental and commercial payers, ensuring adherence to deadlines.
- Tracked and followed up to establish provider numbers linked to appropriate CogentHMG group entity, facilitating timely processing.
- Maintained documentation and reporting regarding Provider Enrollments in process.
- Worked closely with program site management and Cogent corporate resources to expedite completion of forms and requirements, including obtaining signatures, locating required documentation, etc.
- Ensured that established provider numbers were entered into the billing system.
Provider Contractor
Prime Health Services, INC
02.2008 - 09.2010
- Conducted provider recruitment through telephone and in-person interactions and negotiated contracts with hospitals and ancillary providers for the PPO Network.
- Responded to and resolved Provider inquiries regarding Contracting and Credentialing issues for Worker's Compensation, Group Health, Auto Liability, Medicare PPO and Medicare Advantage products.
- Coordinated credentialing paperwork and entered data into the system to streamline processes.
- Analyzed network development and expansion needs, following up with prospective clients to identify opportunities.
Provider Enrollment Specialist
Community Health Systems
08.2005 - 02.2008
- Coordinated credentialing paperwork by communicating with Hospital CEOs, Physicians, MSO office staff, internal VPs, and designated contacts.
- Led project initiatives for assigned hospitals.
- Processed applications for NPI numbers, managed care, and commercial payer provider numbers for physicians and mid-levels.
- Updated and organized credentialing files, applications, and contracts to ensure compliance and accessibility.
- Oversaw hospital projects to enhance operational efficiency and collaboration.
Education
HS Honors Diploma -
Houston County High School
Erin, TN 08.1991 - 05.1995
BS - Organizational Leadership
Bethel University
McKenzie, TN01-2016
Skills
- Credentialing management
- Credential Verification
- Credentialing standards
- Regulatory compliance
- Compliance
- Project Management
- Process Improvement
- Analytics
- Database Management
- Strategic Thinking
- Team Training
- Mentorship
Timeline
Manager, Credentialing & Licensing
PopHealthcare/Emcara
04.2023 - Current
Manager, Payer Enrollment
Privia Health
10.2021 - 04.2023
Director, Credentialing
Upperline Health
10.2019 - 10.2021
Supervisor, Provider Credentialing & Enrollment
PopHealthcare
04.2018 - 10.2021
Managed Care Credentialing Specialist
Brookdale Senior Living, Inc.
03.2015 - 04.2018
Senior Credentialing Specialist
UnitedHealth Group
01.2013 - 03.2015
Credentialing Specialist
Radiology Alliance, PC
09.2011 - 12.2012
Provider Enrollment Coordinator
CogentHMG
12.2010 - 08.2011
Provider Contractor
Prime Health Services, INC
02.2008 - 09.2010
Provider Enrollment Specialist
Community Health Systems
08.2005 - 02.2008
HS Honors Diploma -
Houston County High School
08.1991 - 05.1995
BS - Organizational Leadership
Bethel University