Tanika Kincy
Sacramento,CA
Summary
To be recognized for my value by an innovative, forward-thinking company that enriches the community and offers opportunities for professional growth and life enhancements.
Overview
8
8
years of professional experience
Work History
Configuration Analyst
Blue Shield of California
06.2023 - Current
- Facilitated compliant provider onboarding by translating complex business and regulatory requirements into effective system configurations.
- Designed and implemented intricate configuration solutions that adhered to CMS and NCQA standards.
- Ensured audit readiness and data integrity through meticulous credentialing workflow processes.
- Developed comprehensive documentation for configuration and credentialing in line with governance protocols.
- Conducted regular reviews of configuration processes to enhance efficiency and compliance standards.
- Collaborated with cross-functional teams to streamline provider re-credentialing processes, improving overall operational effectiveness.
SR Provider Relations Representative
Blue Shield of California
07.2021 - 05.2023
- Ensured regulatory compliance by managing enrollment and credentialing for Medi-Cal, Medicare, and PPO.
- Facilitated provider contract processing through effective network recruitment and credentialing workflows.
- Supported network adequacy and provider readiness by efficiently onboarding new providers.
- Collaborated with internal teams to streamline communications and enhance provider onboarding processes.
- Engaged with external providers to maintain adherence to regulatory requirements and operational standards.
- Oversaw onboarding for Enhanced Care Management and Community Supports to optimize service delivery.
- Conducted regular training sessions for staff on credentialing processes and compliance updates.
Account Manager
STATMed
02.2020 - 02.2021
- Ensured compliance with CMS, DHCS, and NCQA standards through diligent credentialing management.
- Oversaw credentialing and re-credentialing processes for large provider groups across multiple programs.
- Served as primary liaison for effective communication between payors and healthcare providers.
- Resolved escalations and grievances, enhancing provider satisfaction and operational efficiency.
- Maintained accurate provider data to support audit readiness and compliance initiatives.
- Fostered strong relationships with providers and clients, enhancing collaboration and service delivery.
- Conducted training sessions for staff on credentialing processes and compliance requirements.
SR Provider Relations Representative
Avesis Incorporated
11.2017 - 11.2019
- Led credentialing and re-credentialing efforts for a large provider network across Medicare, Medi-Cal, and Commercial lines of business, including CalAIM-aligned programs (PAVE, ECM/CS). Acted as escalation lead for complex provider issues and delivered provider education on credentialing requirements, quality standards, and compliance expectations to support provider readiness and continuity of care.
- Dental Providers
Education
Highschool - General
Encina High School
Sacramento, CA01.1999
Skills
- Experienced healthcare administrative and provider operations professional supporting Managed Care Organizations (MCOs) across Medicaid, Medicare, Commercial, and Third-Party programs, including CalAIM initiatives using enhancements such as PAVE and ECM/CS Proven expertise in Provider Network Operations, Credentialing, Contracting, Provider Relations, Account Management, Customer Service, Accounts Receivable Billing, and Claims Management Strong working knowledge of CMS regulations, Medicaid compliance, CAQH, and NCQA standards Technically proficient in Epic, Salesforce, Facets, QNXT, Remedy, Apttus, SQL, CLMS, and other healthcare information systems, with a demonstrated ability to support cross-functional teams and ensure regulatory compliance, operational efficiency, and provider satisfaction with the use of
Timeline
Configuration Analyst
Blue Shield of California
06.2023 - Current
SR Provider Relations Representative
Blue Shield of California
07.2021 - 05.2023
Account Manager
STATMed
02.2020 - 02.2021
SR Provider Relations Representative
Avesis Incorporated
11.2017 - 11.2019
Highschool - General
Encina High School