Tametra Austin
Dallas,TX
Summary
Dedicated healthcare professional specializing in credentialing and enrollment processes. Over a decade of experience in maintaining compliance, enhancing data integrity, and fostering interdepartmental collaboration to streamline operations and reduce denials.
Overview
18
18
years of professional experience
Work History
Credentialing Specialist
Advantage Wound Care
El Segundo, CA
12.2024 - Current
- Handled all aspects of credentialing, recredentialing, and privileging processes for our providers with health plans, maintained CAQH profiles, audited payer directories, and adhered to HIPAA guidelines.
- Processes provider credentialing applications in accordance with accreditation standards, regulatory requirements, and policies and procedures.
- Coordinated and monitored review of provider applications and supporting documents to verify completeness and applicant eligibility.
- Timely completion and processing of enrollment, and credentialing, and validation requirements, while ensuring a high degree of confidentiality.
- Assisted in onboarding and credentialing process for providers and facilities, ensuring compliance with regulatory standards.
- Identify issues that require additional investigation and evaluation, validate discrepancies, and ensure appropriate follow-up.
- Collaborates with health carriers, management team, and others to ensure resolution to enrollment issues.
- Fostered relationships with other departments by providing timely updates on payer enrollment information and application status.
- Ensured the accuracy and integrity of the credentialing database system critical to the enrollment process.
- This role also includes maintaining up-to-date data for each provider in the credentialing and enrollment database, supporting overall processes for receiving and transforming provider data into the operational system for data integration and reporting.
- Responds to inquiries from other healthcare organizations, communicating with management on day-to-day credentialing and privileging issues as they arise.
- Proactively manages revalidation requirements to avoid expiration of important accreditation requirements.
Sr. Credentialing Specialist
Managed Care Children's Health
Dallas, Texas
12.2023 - 12.2024
- Functions as the subject matter expert for the credentialing department. Provides training related to credentialing and payer enrollment that enhances knowledge, develops skills and enriches the team.
- Works collaboratively with Credentialing Manager and Coordinator to promote data integrity and to optimize effectiveness of the Credentialing database, ensuring consistency in data entry rules.
- In collaboration with the Credentialing Manager and Sr. Director, will develop strategic departmental goals to continuously promote efficiency in network participation, reducing denials and increasing net revenue.
- Complete a quarterly roster reconciliation process for all supported practitioners with applicable health plans. Verify accuracy and communicate additions, changes, and corrections in a timely manner, along with necessary supporting documentation.
- Interpreted and ensured compliance with delegated credentialing policies. Conducted annual payor credentialing file audits. Oversaw the submission and tracking of the delegated credentialing roster.
- Collaborated with delegated payer contacts to resolve concerns within the delegation process and strengthen relationships with payers.
- Served as liaison to resolve payer issues and enhance revenue cycle management, collaborating with Patient Financial Services and other billing departments.
- Coordinated with Provider Relations and Network Management on special claim projects.
- Oversaw special projects by developing project plans, anticipating concerns, and providing regular updates to leadership.
- Supports the implementation of new database modules applicable to Managed Care. Implementation includes data migration and validation, as well as data mapping to demographic reports, participation reports, and training.
- Created, maintained, and disseminated plan participation status and billing information to all applicable Children's Health internal departments and third-party billing agencies to maximize collections in the revenue cycle management process.
- Excellent interpersonal skills and ability to work efficiently with internal and external customers. Maintain positive working relationships with payer representatives, providers, and all Children's Health internal departments.
Credentialing/Privileging Specialist
Access TeleCare
Dallas, Texas
06.2021 - 11.2023
- Completed credentialing, re-credentialing, licensing, and privileging activities.
- Granted physician privileges and completed reappointments every 2 years.
- Collaborated with credentialing and licensing teams to maintain accurate and up-to-date provider credentialing files.
- Processed primary source verification to validate healthcare provider credentials.
- Updated credentialing database and provider files to ensure accuracy and compliance with standards.
- Complied with Joint Commission Credentialing Standards.
- Review applications/re-appointments to ensure accuracy and completion.
- Followed up with facilities to address requests and ensure completion of privileging files for timely approval.
- Work with internal teams to ensure files are prepared for privileging process at all client facilities.
- Maintain professional communication with all external customers, coworkers, and management.
- Build and maintain strong working relationships both internally and externally.
- Report on status of all new implementation privileges weekly.
- Use credentialing system to process all facility privilege - ECHO / Salesforce.
Credentialing & Enrollment Specialist
U.S. Dermatology Partners
Dallas, Texas
10.2016 - 06.2021
- Coordinated onboarding process for providers, ensuring compliance with credentialing standards.
- Managed credentialing files for providers, maintaining accuracy and accessibility for audits.
- Streamlined credentialing and re-credentialing applications, reducing processing time for providers.
- Facilitates the enrollment and contracting process for providers. Maintains the CAQH (Council for Affordable Quality Healthcare) repository for providers.
- Provides consultation on enrollment and credentialing processes in every state.
- Provides consultation for the delegated credentialing process.
- Provides credentialing and enrollment consultation for stock and asset purchases.
- Facilitates and manages entity enrollment.
Credentialing & Enrollment Specialist
Intermedix
Texas
07.2015 - 08.2016
- Coordinated credentialing process between practitioners and hospital Medical Staff Office, ensuring compliance with hospital standards.
- Verified online status of State Medical Licenses, Narcotics Certificates, Federal DEA Certificates, Board Certifications, and sanction reports to confirm candidates' eligibility for hospital privileges.
- Analyze the completed hospital application to ensure that the candidate meets the qualifications per hospital bylaws.
- Collaborated with Medical Staff Office to secure primary source verifications, facilitating timely presentation of files to Credentialing Committee and Board of Trustees.
- Obtained case logs and charts on candidates for hospital privileges from prior hospital facilities to determine candidates' experience.
Provider Enrollment Associate
Pediatrix Medical Group
Texas
11.2011 - 07.2015
- Communicated with health plans to clarify processes, establishing and maintaining estimated effective dates for providers.
- Respond promptly to all questions, received via phone or email, regarding any health plan and/or group/pin.
- Request and complete all necessary and appropriate forms for submission to the proper health plan entities.
- Conduct written and oral follow up to determine application status.
- Escalated issues to appropriate management and team members to ensure timely resolution.
- Maintain and update database with both enrollment status and necessary data elements.
- Documented tasks, phone calls, emails, and other communications during enrollment process in database for accurate tracking.
- Prepare check requests for required application fees.
- Updated CAQH database to ensure accurate provider information.
Credentialing & Enrollment Specialist
Emcare-Pinnacle Anesthesia
Texas
01.2009 - 10.2011
- Managed credentialing and provider enrollment for national multi-specialty provider group, ensuring compliance across multiple service lines.
- Facilitated provider enrollment processes with government healthcare payers, managed care plans, and third-party billing entities at regional and divisional levels.
- Maintained and monitored licensure and certifications to ensure compliance hospital client specific criteria.
- Conducted quality audits of practitioner files, verifying compliance through requests to relevant organizations and data banks.
- Acted as the provider relations interface and contracted client hospital liaison.
Education
Bachelor of Science - Criminal Justice
University of North Texas
Denton, TX.12-2012
Skills
- Credentialing
- Provider enrollment
- Primary source verification
- Compliance management
- Data management
- Healthcare administration
- Provider relations
Timeline
Credentialing Specialist
Advantage Wound Care
12.2024 - Current
Sr. Credentialing Specialist
Managed Care Children's Health
12.2023 - 12.2024
Credentialing/Privileging Specialist
Access TeleCare
06.2021 - 11.2023
Credentialing & Enrollment Specialist
U.S. Dermatology Partners
10.2016 - 06.2021
Credentialing & Enrollment Specialist
Intermedix
07.2015 - 08.2016
Provider Enrollment Associate
Pediatrix Medical Group
11.2011 - 07.2015
Credentialing & Enrollment Specialist
Emcare-Pinnacle Anesthesia
01.2009 - 10.2011
Bachelor of Science - Criminal Justice
University of North Texas