Wendy Yule
Phoenix,AZ
Summary
Experienced with credentialing processes and regulatory compliance. Utilizes effective communication and meticulous documentation to manage credentialing for healthcare providers. Knowledge of industry standards and best practices ensures thorough and efficient credentialing operations.
Overview
28
28
years of professional experience
Work History
Credentialing Specialist
Surgical Care Affiliates
11.2021 - Current
- Perform the initial credentialing and re-credentialing functions for all practitioners for each assigned surgery center. Review applications for completion & accuracy & ensure appropriate follow up Monitor & report on the credentialing progress of each practitioner daily/weekly and/or monthly as required.
- Remote work - Multiple facilities in different states
Credentialing Specialist
Azulity (Contracting company) Triwest
07.2025 - 10.2025
- Researched applications to pull from CAQH through Salesforce contracts in order to data enter information into the Virtual Cactus system. Acquiring primary source verifications for education, malpractice, employment, hospital affiliations, licensure & board certification. Utilize internet & phone communication to obtain critical pertinent information to complete files. Ensure clear and accurate communication with practitioners (e.g., answer questions, research data and resolve issues) and sent files to QA. Once submitted through committee and approved, approval letters were created and sent to provider and credentialing contact.
- Systems used: Cactus (desktop & S-provider), CredentialStream, MdStaff & Modio
Credentialing Specialist
Cred2Bill
07.2024 - 12.2024
- Perform the initial credentialing functions for practitioners for multiple clients. Review applications for completion & accuracy & ensure appropriate follow up. Maintain timely and accurate data entry and periodically revise practitioner data in the Modio credentialing database. Acquiring primary source verifications for education, malpractice, employment, hospital affiliations, licensure & board certification. Utilize internet & phone communication to obtain critical pertinent information to complete files. Ensure clear and accurate communication with practitioners (e.g., answer questions, research data and resolve issues). Submitted and followed up with Healthcare plan applications for multiple states.
- Remote Work-Multiple clients/providers in different states
Credentialing Specialist
Chartis
03.2023 - 06.2024
- Perform the initial credentialing functions for practitioners. Review applications for completion & accuracy & ensure appropriate follow up. Monitor & report on the credentialing progress of each practitioner on a weekly basis. Maintain timely and accurate data entry and periodically revise practitioner data in the credentialing database. Acquiring primary source verifications for education, malpractice, employment, hospital affiliations, licensure & board certification. Utilize internet & phone communication to obtain critical pertinent information to complete files. Ensure clear and accurate communication with practitioners (e.g., answer questions, research data and resolve issues). Performed initial primary source verifications and completed NPDB records for 150 Anesthesiologists. Completed primary source verifications for 50 reappointment applications.
- Remote Work-Multiple facilities in different states
Medical Staffing Specialist
HonorHealth
06.2021 - 01.2023
- Manage OnBoarding Process for all new providers which includes educating staff on how the process works and also submitting data on behalf of the provider when appropriate, Interim Data Lead for a team of 4 for all data entry and expirable processes. Review & process providers in the credentialing program for HonorHealth panels to ensure the applications are complete and ready for Committee review. Resolve provider concerns and requests in a timely manner.
- Oversee the maintenance of the data integrity on all incoming information on all applications I am responsible to review and complete. Manage quality standards of the department with verification of provider credentials upon application for credentialing or re-credentialing.
- Address escalated credentialing/re-credentialing database issues. Review applications for completion & accuracy & ensure appropriate follow up Monitor & report on the credentialing progress of each practitioner. Maintain timely and accurate data entry and periodically revise practitioner data.
- Interim Data Lead for a team of 4
Credentialing Specialist
HonorHealth
01.2015 - 06.2021
- Interim Data Lead for a team of 4 for all data entry and expirable processes. Review and process provider applications in the credentialing program for HonorHealth panels to ensure the applications are complete and ready for Committee review. Resolve provider concerns and requests in a timely manner. Oversee the maintenance of the data integrity on all incoming information on applications that I am responsible to review and complete. Manage quality standards of the department with verification of provider credentials upon application for credentialing and re-credentialing. Address escalated database issues. Review applications for completion and accuracy & ensure appropriate follow up. Monitor reports on the credentialing progress of each provider throughout the credentialing or re-credentialing process. Maintain timely and accurate data entry and periodically revise practitioner data when appropriate.
- Interim Data Lead for a team of 4
Medical Staffing Specialist
Terros Health
08.2014 - 01.2015
- Review and process all paperwork for new medical provider hires. Maintain electronic files for all current medical providers. Manage the weekly schedule for contracted RN's through agency communication and coordination with multiple sites, Lead RN's & Site Managers. Coordinate new hire orientation classes between Human Resources Department and new hires. Coordinate data with the Credentialing Department to ensure all paperwork is completed by new hires and submitted for processing in a timely manner.
- Temporary Assignment
- Inspiring Change for Life through Behavioral Health Programs
Credentialing Specialist
Matrix Medical Network
07.2013 - 06.2014
- Perform the initial credentialing functions for employed & contracted practitioners Review applications for completion & accuracy & ensure appropriate follow up (approx. 200 files) Monitor & report on the credentialing progress of each practitioner Maintain timely and accurate data entry and periodically revise practitioner data in the Matrix credentialing database. Enroll practitioners with all appropriate client health plans. Ensure all practitioners who require collaboration agreements are appropriately assigned to a collaborating physician & the agreement is executed by both parties. Ensure employed practitioners are enrolled under the Matrix professional liability insurance plan Respond to all practitioner, client health plan & internal inquiries in a timely manner within one (1) business day Monitor expiring licensure, board & professional certifications & other expirable documents Assisting practitioners with timely renewals of licensure when needed & acquiring new licensure in states when the need arises. Identify, analyze & resolve discrepancies, time gaps & other information Conduct sanctions & compliance monitoring. Utilize internet & phone communication to obtain critical pertinent information to complete files. Ensure clear and accurate communication with practitioners (e.g., answer questions, research data and resolve issues). Implement other team projects as needed Resolve provider concerns in a timely manner Manage entire re-credentialing process from initial contact to Committee approval.
- Remote Work-Multiple clients/providers in different states
Assignment Specialist
Luxottica Retail North America
12.2011 - 07.2013
- Manage data integrity and maintenance for the enrollment and re-enrollment of all managed care employed doctors and corporate stores in the Medicare program. Lead process improvements for the Medicare program and Assignment Payers. Address and resolve escalated issues for Assignment payers for the managed care and the Medicare programs Liason between stores, collections/claims teams, third party vendor and Top Assignment payers Resolve customer/payer/provider issues or complaints by determining optimal solutions Manage and Implement other team projects as needed. Create and distribute monthly location files for managed care Assignment payers Website administrator for Assignment website launched in November of 2012 Manage plan audits and report on results. Address/research and resolve escalated issues Review and report details on Payer Contracts Make data changes requested by provider (e.g., address, tax id, and/or business name changes) Compile monthly Medical Billing close reports and distribute. Create and monitor weekly Medical Billing claims report. Create and distribute monthly location files for Assignment payers
- Manage data integrity and maintenance for the enrollment and re-enrollment of all managed care employed doctors and corporate stores in the Medicare program.
Medical Billing Services/Medicare Specialist
Luxottica Retail North America
02.2010 - 12.2011
- Manage data integrity and maintenance for the enrollment and re-enrollment of all employed doctors and corporate stores in the Medicare program. Lead process improvements for the Medicare and Medical Billing programs Address/research and resolve escalated issues. Manage credentialing for Pearle managed care employed doctors on specific plans for Medical Billing Manage the relationships with payers for the Medical Billing plans. Liason between stores, collections/claims teams, third party vendor and Top Assignment payers Resolve customer/payer/provider issues or complaints by determining optimal solutions Responsible for all follow up with providers to obtain missing information. Ensure clear and accurate communication with professional providers. Team projects as needed.
- Manage data integrity and maintenance for the enrollment and re-enrollment of all employed doctors and corporate stores in the Medicare program.
Medicare Administrator
Luxottica Retail North America
05.2008 - 02.2010
- I applied for and maintained Medicare enrollment applications for all Corporate locations (800) and all employed doctors (300). Resolve doctor and store concerns in a timely manner. Oversee the maintenance of the data integrity on all doctor profiles and store records Oversee the enrolling and re-enrolling of all employed managed care doctors and stores in the Medicare program Lead process improvements for the Medicare program Address and resolve escalated issues Resolve customer complaints by determining optimal solutions Responsible for all follow up with providers to obtain missing information Ensure clear and accurate communication with professional providers (e.g., answer questions, research data and resolve issues). Implement other team projects as needed Make data changes requested by provider (e.g., address, tax id, and/or business name changes). Create and distribute monthly location files for Assignment payers.
- I applied for and maintained Medicare enrollment applications for all Corporate locations (800) and all employed doctors (300).
Business License and Medicare Supervisor
Luxottica Retail North America
10.2005 - 05.2008
- I managed a group of associates that applied for and maintained business licenses for all Corporate locations as well as Medicare enrollment applications for all Corporate locations and all employed doctors. Resolve doctor and store concerns in a timely manner. Oversee the maintenance of the data integrity on all managed care doctor profiles, store records and business license records. Oversee the enrolling and re-enrolling of all employed doctors and stores in the Medicare program Oversee the business license process to ensure stores and opticians are currently licensed to practice in the correct jurisdictions. Lead process improvements for both the business licensing and Medicare programs Lead and train team members effectively to reach desired goals. Create an environment that fosters cooperation, teamwork and trust to build on associates' strengths, achieves positive results by demanding quality performance of the entire team Ensures proper training, feedback and support for all team members Serve as a liaison to the Sales Tax Department as needed. Address escalated issues for both groups Supervise a team of 4.
- I managed a group of associates that applied for and maintained business licenses for all Corporate locations as well as Medicare enrollment applications for all Corporate locations and all employed doctors.
Credentialing Supervisor
EyeMed Vision Care (A Division of Luxottica Retail North America)
08.2001 - 01.2005
- I managed the process of enrolling doctors in the credentialing program for EyeMed Vision Care to ensure they were approved and active to service customers. Implement and lead programs designed to deliver provider satisfaction to approved levels within the Managed Care Organization. Resolve provider concerns in a timely manner. Oversee the maintenance of the data integrity on all incoming information. Coordinate meetings, set goals and monitor the productivity of the Provider Relations Team Manage the managed care credentialing and re-credentialing program to follow NCQA standards Lead the annual review of the Certified Verification Organization (CVO); lead new vendor search/selection process if/as needed. Oversee all credentialing/re-credentialing activities; lead process improvement Lead person on Provider Relations projects and research as needed. Primary liaison for all IPA group relationships (e.g., monthly payments, ensuring providers are added or deleted from the system as necessary, re-credentialing). Lead and train managed care team members effectively to reach desired goals. Create an environment that fosters cooperation, teamwork and trust to build on associates' strengths, achieving positive results by demanding quality performance of the entire team Ensure proper training, feedback and support for all team members. Manage quality standards of provider participation with verification of provider credentials upon application for enrollment or re-enrollment in the EyeMed network. Serve as a liaison to the Provider Relations call center and provide training if/as needed Address escalated credentialing/re-credentialing database issues. Supervise a team of 8.
- I managed the process of enrolling doctors in the credentialing program for EyeMed Vision Care to ensure they were approved and active to service customers.
Credentialing Administrator
Care Plan of America
12.1999 - 05.2001
- Review all provider managed care credentialing applications Data Entry of complete provider credentialing applications. Manage the process for compiling, stuffing, and mailing packets Responsible for all follow up with providers to obtain missing information. Provide data to ensure quality assurance compliance. Ensure programs are maintained consistently per standards. Ensure clear and accurate communication with professional providers (e.g., answer questions, research data and resolve issues). Implement other team projects as needed. Make data changes requested by provider (e.g., address, tax id, and/or business name changes).
- Review all provider managed care credentialing applications Data Entry of complete provider credentialing applications.
Credentialing Specialist
MedIntel-IRIS
12.1997 - 10.1999
- Ensure programs are maintained consistently per NCQA standards .Review all provider credentialing applications. Train individuals as needed to ensure NCQA compliance in the verification process Data Entry of complete provider credentialing information. Manage client reporting functions. Responsible for all follow up with providers to obtain missing information Ensure clear and accurate communication with clients. Implement other team projects as needed. Make data changes requested by client (e.g., address, tax id, and/or business name changes) Request verification information from education entities, insurance companies and licensing boards Manage process changes with direction from the NCQA Program. Supervise a team of 6
- Ensure programs are maintained consistently per NCQA standards .Review all provider credentialing applications.
Education
High School - General
Carl Hayden High School
Phoenix, AZSkills
- HIPAA compliance
- Provider enrollment
- Background checks
- Data management
- Provider relations
- Application coordination
- Database maintenance
- Credentialing documentation
- Microsoft office
- Analytical and critical thinking
- Conflict resolution
- Teamwork and collaboration
- Willingness to learn
Timeline
Credentialing Specialist
Azulity (Contracting company) Triwest
07.2025 - 10.2025
Credentialing Specialist
Cred2Bill
07.2024 - 12.2024
Credentialing Specialist
Chartis
03.2023 - 06.2024
Credentialing Specialist
Surgical Care Affiliates
11.2021 - Current
Medical Staffing Specialist
HonorHealth
06.2021 - 01.2023
Credentialing Specialist
HonorHealth
01.2015 - 06.2021
Medical Staffing Specialist
Terros Health
08.2014 - 01.2015
Credentialing Specialist
Matrix Medical Network
07.2013 - 06.2014
Assignment Specialist
Luxottica Retail North America
12.2011 - 07.2013
Medical Billing Services/Medicare Specialist
Luxottica Retail North America
02.2010 - 12.2011
Medicare Administrator
Luxottica Retail North America
05.2008 - 02.2010
Business License and Medicare Supervisor
Luxottica Retail North America
10.2005 - 05.2008
Credentialing Supervisor
EyeMed Vision Care (A Division of Luxottica Retail North America)
08.2001 - 01.2005
Credentialing Administrator
Care Plan of America
12.1999 - 05.2001
Credentialing Specialist
MedIntel-IRIS
12.1997 - 10.1999
High School - General
Carl Hayden High School