Taniesha Sanders
Tracy,CA
Summary
Healthcare professional prepared to excel in administrative roles, leveraging rich background in managing healthcare facilities. Proven ability to enhance operational workflows and maintain regulatory compliance. Focused on collaborative team efforts and delivering impactful results, known for flexibility and reliability.
Overview
9
9
years of professional experience
Work History
Director of Medical Staff Services
Doctors Hospital of Manteca
03.2023 - Current
- Expertise in credentialing and privileging procedures for healthcare providers
- Ensured compliance with accreditation standards and regulations (e.g., The Joint Commission, CMS)
- Developed and maintained credentialing policies and procedures
- Collaborated with medical staff, administration, and various departments to facilitate effective communication and coordination
- Strong interpersonal skills to interact with diverse healthcare professionals and stakeholders
Quality Assurance Manager
Veteran Affairs Health Care
06.2022 - 03.2023
- Develop, implement, and manage the healthcare facility's quality assurance (QA) program
- Oversee all QA and compliance functions to identify areas for improvement
- Design and implement a comprehensive plan to track quality metrics and enhance existing practices
- Monitor and assess adherence to healthcare regulations and accreditation standards
- Ensure healthcare providers and facilities follow established QA protocols
- Develop and update policies and procedures to reflect changes in regulations
- Train staff on quality standards and ensure their understanding of QA procedures
- Analyzed data to identify areas for improvement in the QA program, resulting in a 15% reduction in readmission rates
Credentialing & Privileging Manager
Veteran Affairs Health Care
08.2020 - 12.2022
- Serves as an executive leadership advisor and system consultant on medical staff and credentialing accreditation compliance for the medical center
- Oversight of 16 direct Reports and their professional development, 1:1 coaching, and corrective action as needed
- Successfully decreased backlog of 220 provider files by 65% in 45 days of implementing a new processes and new efficient staff training
- Prepares and responds to accreditation reviews and ongoing compliance with regulatory standards, including but not limited to, TJC, Office of Inspector General/Combined Assessment Program (OIG/CAP), System-wide Ongoing Assessment and Review Strategy (SOARS)
- Led the department in developing and implementing efficient credentialing processes, ensuring timely provider onboarding and compliance with all regulatory standards
- This resulted in a 20% reduction in credentialing turnaround time and improved patient access to care
Credentialing and Contracting Coordinator
Curant Health
06.2019 - 08.2020
- Track and manage all pharmacy network contract, pharmacy accreditations, regulatory license submissions
- Facilitate prescription benefit management (PBM) network agreements from multimillion-dollar accounts to include BCBS, Aetna, Cigna, etc
- Enroll company pharmacies in State Medicaid Agencies for all 50 states
- Cross-functional collaboration with the sales team for initial contract presentation and contract modifications
- Proficient at claim conflict resolution between payer and members for claim denials and benefit explanations
- Complete all requirements for information, licensing documentation, credentialing, re-credentialing, and payer contracts
- Well versed in the requirements and qualifications for maintaining accreditations with URAC, VIPPS, and ACHC
- Sole accountability for data analysis and reporting for various project activities
- Accountable for dissemination of PBM network formulary changes to the Sr
- Director of Pharmacy Compliance and Contracting, ensuring accuracy and integrity of the projects and programs
- Participated and tracked billing audits for third-party payers when requested
Credentialing Coordinator/ Executive Assistant/ HR Assistant
Ridgeview Institute/US Healthvest
03.2018 - 08.2020
- Navigated medical providers in the credentialing process, validating their registration with managed care, governmental agencies, and participating insurance companies
- Verified providers’ credential documentation through the state License Board, DEA, NPDS, FSMB, Medicaid Opt-out, and Board Exclusion
- Accomplished JACO survey, CMS, and State survey at 100% for the hospital
- Narrowed credentialing process from 30-60 days to 2 weeks maximum
Credentialing Coordinator/ Provider Enrollment
American Family Care
10.2017 - 10.2018
- Independently analyzed reports and communicates any reimbursement trends or delays to hospital offices
- Processed any necessary insurance/patient correspondence and coordinated with office staff to obtain appropriate medical records as they relate to the reimbursement process or provider credentialing
Credentialing Coordinator
Tulane Medical Center
09.2016 - 08.2017
- Expertly navigated medical providers in the credentialing process, validating their registration with managed care, governmental agencies, and participating insurance companies
- Highly proficient with proprietary software, to include CACTUS and MEDITECH, as well as Microsoft Office
- Completed credentialing for current providers within 3-4 months in advance
- Completed initial credentialing process from 60-180 days to 30-60 days
Credentialing Coordinator
Memorial Hospital at Gulfport
04.2016 - 08.2016
- Provide administrative support for the Provider Participation Credentialing Program to ensure that all provider information is current and accurate
- Retrieves providers credential paperwork through the state License board, DEA, NPDS, FSMB, Medicaid opt out, Board Exclusion, Death master file
- Completed back logged credentialing from a year to completing credentialing packets for the following two months
Education
Master of Science - Finance
Southern New Hampshire University
Hooksett, NH06-2025
Master’s - Public Health- Healthcare Administration
National University
La Jolla, CA01.2017
Bachelor of Science - Finance and Corporate Management
California State University East Bay
Hayward, CA01.2015
Associates of Arts - Business Administration
Monterey Peninsula College
Monterey, CA01.2011
Skills
- Initial and Reappointments
- Meeting Management
- Manager experience
- Billing and Coding
- Provider Enrollment
- NPPES
- Developing Policies and Procedures
- Quality Assurance Management
- Auditing
- PECOS
- PIMS
- Training
- CAQH
- Accreditation – TJC
- Accreditation – OIG
- Accreditation – NCQA
- Accreditation – VIPPS
- Accreditation – ACHC
- Accreditation - URAC
- Adobe Acrobat
- FPPEs
- OPPE
- Verbal and written communication
- Strategies and goals
- Negotiation
- Rules and regulations
Affiliations
- Member of NAMSS
- Member of CAMSS
- Member of CEPH
- Member of ACHE
Timeline
Director of Medical Staff Services
Doctors Hospital of Manteca
03.2023 - Current
Quality Assurance Manager
Veteran Affairs Health Care
06.2022 - 03.2023
Credentialing & Privileging Manager
Veteran Affairs Health Care
08.2020 - 12.2022
Credentialing and Contracting Coordinator
Curant Health
06.2019 - 08.2020
Credentialing Coordinator/ Executive Assistant/ HR Assistant
Ridgeview Institute/US Healthvest
03.2018 - 08.2020
Credentialing Coordinator/ Provider Enrollment
American Family Care
10.2017 - 10.2018
Credentialing Coordinator
Tulane Medical Center
09.2016 - 08.2017
Credentialing Coordinator
Memorial Hospital at Gulfport
04.2016 - 08.2016
Master’s - Public Health- Healthcare Administration
National University
Bachelor of Science - Finance and Corporate Management
California State University East Bay
Associates of Arts - Business Administration
Monterey Peninsula College
Master of Science - Finance
Southern New Hampshire University
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