SUMMARY

• Dedicated and motivated Data Analysis eager to contribute to team success through hard work, attention to detail and excellent organizational skills. Proven ability to understand customer requirements and translate into actionable project plans. Exceptional skill in SQL - based environments. Well-coordinated in addressing problems, investigating root causes and implementing successful resolutions.

PROFESSIONAL EXPERIENCE

Health Plan Data Analyst

Confidential, Houston, TX

Responsibilities:

• Collected and analyzed information to monitor compliance outcomes and identify and address trends of non-compliant.
• Excellent interpersonal and communication skills. Ability to deliver complex information in a clear, concise, and relevant manner.
• Ability to set and meet deadlines with excellent attention to detail.
• Knowledge of managed care rules and regulations.
• Trains and coaches less-experienced healthcare data analysts on data retrieval techniques,
• Generated database reports, presentation, and documentation of analytical methods.
• Experience leading projects from concepts to results.
• Strong time management and organizational skills to manage multiple projects.

Senior Credentialing Specialist

Confidential, Houston, Tx

Responsibilities:

• Conducted primary source verifications such as background checks and board certifications.
• Received and evaluated applications to look for missing and inaccurate information.
• Obtained NPI numbers for providers and facilities and updated existing profiles.
• Prepared records for site visits and file audits.
• Worked alongside global business leader to deploy new training strategies.
• Improved office efficiency by effectively managing internal communications and correspondence.
• Improved organizational filing systems for confidential employee records, resulting in improved accessibility and efficiency.
• Maximized team knowledge and productivity by effectively training, monitoring and directing employees in application of best practices and regulatory protocols.

Credentialing Manager

Confidential, Jacksonville, AR

Responsibilities:

• Oversaw credentialing process across multiple entities: support in managing provider credentialing processes to ensure the practices polices and /workflows are following guidelines and contracted health plan directives.
• Participated in quality improvement activities to ensure compliance and continuous improvement of signify health policies and procedures related to contracted physician clinical interaction, credentialing and quality assurance.
• Created, implemented and measured an operating strategy for the MSO team that is designed to assist in achieving divisional goals.
• Chaired weekly meetings with executive leadership to identify opportunities for improvement, establish milestones and tailor products to individual markets.
• Increased operational efficiency by developing improved filing systems for confidential client records and reports.
• Supervised site investigations, reported issues and escalated those that required further assistance.
• Improved staff morale and reduced employee turnover by 99%.
• Improved staffing during busy periods by creating employee schedules and monitoring call-outs.
• Set, enforced and optimized internal policies to maintain efficiency and responsiveness to demands.

Credentialing Specialist

Confidential, Houston, TX

Responsibilities:

• Gathering and integrating data from disparate sources.
• Building models and analyzing data to trends and patterns.
• Presenting and explaining information, and suggesting improvements.
• Collaborate with management and internal teams to implement and evaluate improvement.
• Ability to set and meet deadlines with excellent attention to detail.
• Build client reports and contribute to monthly or quarterly updates.
• Assist in the data integration process, including design of database views, running reports, and maintaining documentation.
• Suggest ways to both increase healthcare quality and reduce costs.

Senior Credentialing Specialist

Confidential, Houston, TX

Responsibilities:

• Processed and managed credentialing and re-credentialing in strict accordance with CPC policy and procedure, Joint Commission Standards, State and Federal Regulatory regulations.
• Spearheaded the handling of all credential files and ensuring they were up to date, in complete pursuant to expiration date of medical licenses, board certification, professional-liability insurance coverage, DEA and other pertinent information, per CPC policy and procedure.
• Ensured the data collection systems were developed and maintained in a timely manner to support managed care contracting and decision making.
• Partnered with compliance and internal audit department to assure compliance to regulatory and customer requirements.
• Prepared records for site visits and file audits.

Credentialing Specialist

Confidential, Little Rock, AR

Responsibilities:

• Partnered with compliance manager and residence operating manger in obtaining and correcting documentation and resolving other issues as they arise.
• Collaborated with senior compliance specialist in maintaining database and increasing productivity.
• Formulated reports and contributed to the training needs.
• Handled compliance with state and federal agencies.
• Analyzed records, reports, projects, regulations and procedures, made recommendations to client based upon findings.