Centers Plan for Healthy Living

• Manage over 200 assigned practitioner files and execute credentialing and re-credentialing functions in accordance with company policies and procedures, NCQA guidelines, and applicable State and Federal Regulations.
• Review practitioners' credentialing applications and supplemental documents to ensure accuracy and compliance with criteria for network participation (Since August 2021, 37.5% of assigned provider files are either approved or in pending final approval status).
• Run primary source verifications of provider credentials - including state licensure, DEA certificates, board certifications, malpractice and adverse action history - and exclusion checks.
• Collaborate with internal departments and external contacts to obtain missing documentation to complete files.
• Provide one-on-one training to new hires.

Credentialing Specialist

• Educated members and caregivers on the requirements of the Consumer Directed Personal Assistance Service (CDPAS) program.
• Processed cases for average of over 150 members using CaseTrakker and Salesforce databases
• Conducted weekly outreaches to home care vendors to ensure that caregivers are fully registered within established timeframes.
• Initiated contacts with medical providers to obtain requisite documentation to complete cases, as per
NYS Department of Health (NYS DOH) regulations.
• Analyzed weekly reports and informed management of case statuses and any related issues.

CDPAS Coordinator

Manhasset Public Library

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Integra Managed Care

Temporary assignment at Integra MLTC

• Assisted HR and Recruitment team with daily operations, including resume review,
outreaches to prospective candidates, background checks, updating job requisitions, coordinating background checks and drug screens and orientation setup.
• Oversaw recruiters’ calendars and scheduled interviews.
• Compiled and maintained reports regarding statuses of new hires to expedite onboarding.

Talent Acquisition Coordinator

Temporary assignment at Integra MLTC.

• Assisted in review of members' requests pertaining to services that require prior authorization.
• Generated letters for members regarding service approvals, denials and changes (e.g. CDPAS,
PCA, Physical Therapy, DME).
• Escalated cases to next-level clinical reviewers (i.e. nurses) if they did not meet criteria for approval

Utilization Management Coordinator

EBS Healthcare

Brennen School/Delaware Autism Program
Appoquinimik School District

Speech-Language Pathologist (Clinical Fellow)

Stony Brook University Psychology Department

In the paper attached below, my name, listed as "S. Eng", is mentioned in the Acknowledgements section.  I was responsible for transcribing the data for this study.

Research Assistant

Reliable Credentialing Specialist with 3 years of experience in the Managed Care industry and a proven record of meeting projects under tight deadlines.  Proficient in Microsoft Office, customer service (in-person and telephonic) and electronic health records systems.

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