TERESA H. MASSE

Company Downsized and closed Credentialing/Billing Down

• Maintained positive customer relations by addressing problems head-on and implementing credentialing updates weekly.
• Weekly meetings with 23 franchises on the status of Credentialing/Contracting applications.
• View weekly payer reports to make sure insurance status's are up to date and accurate.
• Enroll providers/locations with payers.
• Call insurance companies on the status's of payer applications and update the information and documents in Modio.
• New on boarding of Franchises, coordination of contracting and credentialing.

• Enrolled providers and Medicaid, Medicare and Commercial payers.
• Work with providers (clients) to start up their practice and facilities for credentialing, and credentialing process.
• Enter information/data in Modio and update demographics.
• Payer status calls, follow up on the credentialing status's on the applications.
• Assist other credentialing specialist with licensure, and credentialing enrollment.

• 2019 Hired as FT Credentialing Specialist, in 2020 stayed on staff did PRN work. In 2021 I was asked to be Director of Credentialing. Then to the Human Resources Department as HR Operations Specialist to assist with company merger.
• Maintained individual provider files to include up to date information needed to complete required governmental and commercial payer credentialing applications.
• Updated each provider's CAQH database file according to schedule published by CMS,
• Started the credentialing department with 5 employees that expanded to over 15 employees in one year with no turnover.
• Oversaw credentialing for over 2,000 providers and 52 locations with different Tax identification numbers in the Eastern, Central, and Western United States.
• Held monthly meetings with each location and the providers/managers to give updates on the provider payer status's.
• Completed credentialing applications to add providers to commercial payers Medicare, and Medicaid as well as delegated plans.
• Responsibility for all Availity directories, and up keep of portal.
• Worked closely with revenue cycle team to identify and resolve any denials or provider credentialing issues.
• Maintain accurate provider profiles on CAQH, PECOS, NPPES, AVAILITY and CMS databases..
• Responsible for all HR functions hiring, management, training and coaching employees.
• Worked with various departments to improve function with-in department.
• HR-New hire on boarding for locations, in ADP, salary increases, transfer requests. Worked with employees with benefit enrollment for 50 different locations.
• Directed each phase of hiring process, encompassing employment verification, employee relations investigations, criminal background checks and onboarding.

• Received and evaluated applications to look for missing and inaccurate information.
• Conducted primary source verifications such as background checks and board certifications.
• Chart Verifications for site visits and file audits.
• Protocols for Physician Assistant's and submitted them to the state for processing.
• Initial Hospital and Surgery Center applications, follow thru until provider starts with group.
• Re-Credentialing Applications for providers for Baycare Board approval.
• Behavior Health grid in Excel to sent out weekly notices, and non delegated applications for Behavior Health to the locations on the payer status's.
• Staff Timecards verification, and checks weekly in Kronos.
• Assist CVO office with items that they will need to approve providers.
• All new credentialing: verifications: DEA, State License, SAMS, OIG, NPPES Verification, Education.
• Obtained NPI numbers for providers and facilities and updated existing profiles.
• Prepared records for site visits and file audits.

• Credentialed all new providers with Commerical, and Medicare payers.
• Built database for over 100 physicians to Credentialmydoc software from CAQH and implemented new software set up.
• Maintained state license and liability certificates for all 1099 Providers.
• Credentialed with 36 locations throughout FL, GA, IL.
• Update each provider's CAQH database files.
• Credentialed for Medicare and Medicaid Physicians and all locations.
• Worked closely with practitioners to help each obtain privileges at assigned healthcare facilities,

• Created CAQH accounts for all Therapist.
• Captured key feedback from employees during exit interviews.
• New hire orientation and paperwork; I-9 forms, W-4, contracts, health benefits and 401K
• E-verify extensive training.
• Maintained rosters for insurance companies thru Availity.
• ACHA II fingerprinting training for county school system.
• Maintained all personal files for Human Resources audit.

• Submitted credentialing applications for hospitals, surgery centers and commercial companies for provider.
• Recruited, hired, trained and supervised administrative office staff of 5.
• Established and developed highly-efficient and dependable administrative team by delivering ongoing coaching and motivation while providing opportunities for patient care. Addressed any patient issues.
• HIPPA Yearly Training for all staff, and updated what was needed for compliance.
• Updated all Meaningful Use Measures as well as Electronic Medical Records.
• Licensed all equipment in office: Nuclear Testing, Echo's, and Stress Testing for state accreditations.

• Credentialed all providers every 3 years for committee with delegated rosters.
• Data entry in Kronos for all new hires to meet accreditation standards.
• Information processing for board meetings, and workman's comp claims.
• Assist all employees with questions in regards to; benefits, 401(k) plans, transfer's, new hire's, and orientation, and leave of absence.
• Benefit Enrollment meetings yearly to assist employees during enrollment period.

• Submitted credentialing commercial, Medicare/Medicaid applications for physicians, and physician assistants for surgery centers, insurance companies and hospitals.
• Human Resources Items: ADP Payroll, monitoring work & schedules for 60 employees, all hiring process and recruiting. 401 (K) enrollments.
• Bookkeeping: Monitoring bank accounts, deposits, work with accountant monthly reporting, Quickbooks entry and deposits. and loans.
• Oversaw a staff of 50 employees, and 5 physicians in 4 different Radiation Oncology locations.
• Marketing: Monitoring new patients, outside marketing to physicians, health fairs, budgeting.
• Facilities: Oversee when facilities need care for equipment, and up-keep.
• Maintained all licensure for all four facilities with the State of Florida.
• Trained new staff on quality control procedures.

• Supervised the integrity of the reception desk, oversaw twelve employees that processed on averaged 300 patients daily.
• Maintained ten physicians, and four physician assistant schedules, time-off etc.
• Monitored all cash flow of the front office, including collection accounts, bank deposits.
• Participated in the selection of hiring the reception staff, and responsible for their training.
• Helped design, and move a new office for the physicians.
• Assisted patients with questions, and items of concern.
• Watson Clinic (merger with Bloomingdale Medical Associates 1996.

• COMPANY MERGER, MERGED THEN CLOSED
• Worked as Office Manager for Internal Medicine, and Pediatrics.
• Served as liaison between offices, and Watson Clinic.
• Supervised staff in all clinics including six physicians, and 40 employees.
• Worked with patient's to make sure they received care, and handled any complaints.
• Coordinated set-up of a new Pediatric clinic with Watson Clinic including all development and planning of new facility.