Tammy L. Ashley
Ocean Isle Beach,NC
Summary
Dynamic Credentialing Specialist with proven success at PediatriCare of Northern VA, PC, enhancing operational efficiency through the development of robust credentialing policies. Skilled in managing provider enrollments and maintaining compliance, while demonstrating exceptional interpersonal communication and organizational abilities. Adept at navigating complex healthcare environments, ensuring accuracy and confidentiality in all processes.
Overview
24
24
years of professional experience
Work History
Credentialing Specialist/Collections Coordinator
PediatriCare of Northern VA, PC
Manassas, VA
07.1997 - 02.2021
- Developed and implemented credentialing policies and procedures to improve workflow.
- Set up NPI numbers for providers and facilities and updated current profile information.
- Coordinated with healthcare professionals to collect necessary documentation for credentialing.
- Responded to verification inquiries from other healthcare organizations and insurance companies.
- Maintained up-to-date records of credentialing statuses in database systems.
- Ensured strict confidentiality of provider information in accordance with HIPAA regulations.
- Trained junior credentialing staff
- Liaised with insurance companies to complete provider enrollment and ensure billing capabilities.
- Reviewed and processed credentialing applications to ensure accuracy, completeness, and compliance with all accreditation standards.
- Processed re-credentialing applications for existing providers according to contractual requirements.
- Monitored expiration of licenses and certifications, notifying providers of renewal requirements.
- Maintained detailed records of provider data in the credentialing database system.
- Completed enrollments into Medicaid, Medicare and private insurance plans.
- Managed end-to-end provider credentialing process, ensuring compliance with industry standards.
- Prepared and submitted detailed reports on credentialing progress to management.
- Interacted regularly with representatives from health plans and commercial payers regarding credentialing matters.
Education
Some College (No Degree) - Information Management
Randolph Macon College
Ashland, VASkills
- Prior experience working in a patient-focused pediatrics environment, as well as radiology and interventional radiology
- Possess strong interpersonal communication skills
- Intuitive technical capabilities with the ability to quickly understand and apply working knowledge
- Worked independently and was able to assess a situation, consider alternatives and choose the appropriate course of action
- Possess sound organizational abilities, constructive time management skills, and can effectively set priorities
- Prior successful experience in a virtual team environment
- Ability to multi-task in stressful and limited time constrained environment
- Maintain strict confidentiality and professional discretion
Timeline
Credentialing Specialist/Collections Coordinator
PediatriCare of Northern VA, PC
07.1997 - 02.2021
Some College (No Degree) - Information Management
Randolph Macon College
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