Val S. Williams

• Tracked and managed payer revalidation dates for assigned groups/providers.
• Completed, submitted, and monitored applications to maintain active enrollment and prevent deactivation.
• Retained records of completed CMS applications for compliance purposes.
• Maintained provider demographics in all applicable enrollment systems.
• Added providers to relevant systems, ensuring claims processing aligns with enrollment status.
• Conducted follow-ups with market locations to address and resolve payer enrollment issues.
• Resolved payer enrollment issues through effective communication with Centers for Medicare & Medicaid Services (CMS) and other payers.
• Managed completion and submission of CMS Medicare, State Medicaid, and third-party applications.

Company Overview: Sentara Healthcare

• Review providers Medicare/Medicaid enrollment applications and or contracts for completeness and accuracy.
• Ensure all payor enrollments and revalidations are completed on deadline(s)
• Maintains active up to date provider records.
• Communicate effectively with providers to obtain necessary documents, clarify any discrepancies, issues and missing information.
• Utilize credentialing software to organize, update payor database insuring data is correct and complete.
• Verify with licensing board, professional sanctions, general risk/liability for active coverage
• Sentara Healthcare

• Ensured accurate loading of provider information for efficient claims processing.
• Loaded provider demographics and affiliations according to Medicare and Medicaid contract guidelines.
• Utilized appropriate templates and analysis tools for documentation and implementation tasks.
• Adhered to business requirements for Non-Par and Par providers in contracting and credentialing.
• Analyzed trends in claims processing, identifying issues for resolution.
• Conducted audits on provider tasks to validate quality and financial accuracy, providing documented feedback.
• Determined network pricing based on regional analysis and provider contracts.

• Credentialed and re-credentialed provider files to uphold compliance standards.
• Maintained accurate provider data in credentialing platform for operational efficiency.
• Verified and updated provider demographics to ensure data integrity.
• Executed primary source verifications according to professional level requirements.
• Conducted thorough assessments of risk and liability based on qualifications and experience.
• Monitored sanctions monthly to guarantee ongoing regulatory compliance.
• Performed comprehensive checks on licensing boards, federal and state sanctions, and malpractice coverage.
• Ensured adherence to relevant regulations during all verification processes.