Nichole McCauley
Saint Peters
Summary
Dynamic Senior Credentialing Specialist with extensive experience at USA Radiology Management Solutions, adept at enhancing credentialing processes and ensuring HIPAA compliance. Proven ability to manage provider enrollment and conduct thorough background checks, while fostering strong provider relations. Recognized for exceptional problem-solving skills and improving turnaround times for applications.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Senior Credentialing Specialist
USA Radiology Management Solutions, LLC
10.2020 - Current
- Collaborated with healthcare providers to gather necessary information for accurate credentialing decisions.
- Managed multiple priorities effectively, resulting in the on-time completion of credentialing tasks for numerous providers simultaneously.
- Conducted audits of provider files, ensuring all necessary documents were up-to-date and compliant with regulatory requirements.
- Enrolled providers and Medicaid and Medicaid.
- Conducted primary source verifications such as background checks and board certifications.
- Safeguarded confidential provider information by adhering to strict data privacy regulations and company policies.
- Facilitated communication between departments, resulting in improved collaboration during the credentialing process.
- Received and evaluated applications to look for missing and inaccurate information.
- Obtained NPI numbers for providers and facilities and updated existing profiles.
- Expedited the onboarding process for new providers, ensuring timely completion of all required documentation and verifications.
- Enhanced credentialing processes by streamlining documentation and verification procedures.
- Developed strong relationships with external organizations, leading to increased cooperation during verification processes.
- Maintained a thorough understanding of accreditation standards, enabling accurate interpretation of guidelines for staff members when needed.
- Provided exceptional customer service to both internal and external stakeholders, addressing inquiries promptly and professionally.
- Improved turnaround time for credentialing applications by implementing an efficient online system.
Medical Assistant II
Mercy
01.2020 - 10.2020
- Sanitized, restocked, and organized exam rooms and medical equipment.
- Obtained client medical history, medication information, symptoms, and allergies.
- Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
- Performed medical records management, including filing, organizing and scanning documents.
- Maintained a safe and clean clinical environment by adhering to infection control guidelines and disposing of biohazardous waste properly.
- Facilitated seamless patient care with thorough and accurate documentation of medical histories, vital signs, and medications.
- Kept medical supplies in sufficient stock by monitoring levels and submitting replenishment orders before depleted.
- Performed phlebotomy tasks efficiently while ensuring minimal discomfort for patients during blood collection procedures.
- Empowered patients through education on self-management techniques for chronic conditions.
- Performed EKGs and other diagnostic tests, contributing to accurate and timely diagnoses.
- Improved clinical workflow with introduction of electronic health records system.
Practice Manager
Katalyst Pain Management and Treatment Center
05.2014 - 12.2019
- Addressed patient concerns promptly and professionally, demonstrating empathy and excellent problem-solving skills.
- Managed daily practice operations to optimize appointment scheduling, patient records management and billing functions.
- Ordered all office supplies and kept check on inventory levels.
- Facilitated communication between staff members, fostering a collaborative work environment that improved overall team performance.
- Oversaw the hiring process for new employees, selecting candidates who aligned with the practice''s mission and values.
- Oversaw accounting, budgeting, and financial reporting.
- Managed office budget, reducing unnecessary expenses and allocating funds for necessary improvements.
- Provided supervision and management to team of support personnel.
- Increased patient satisfaction by streamlining appointment scheduling and implementing efficient check-in processes.
- Coordinated with insurance providers to streamline the billing process and minimize any delays in reimbursement.
- Negotiated contracts with vendors, securing favorable terms for the practice while maintaining quality service levels.
- Spearheaded initiatives aimed at improving community relations, including hosting events such as health fairs or seminars on relevant topics in healthcare management.
Education
Certified Physician Licensing Specialist - Medical Licensing
Team Med Global
Online03-2024
Graduate Certificate - Medical Assisting
Midwest Institute
Maryland Heights, MO10-2009
High School Diploma -
Francis Howell High School
Saint Charles, MO06-2004
Skills
- HIPAA compliance
- Provider enrollment
- Background checks
- Data management
- Credentialing oversight
- Provider relations
- Application coordination
- Insurance procedures
- Application management
- Document review
- Data acquisition
- Proofreading
- Database maintenance
- Employee onboarding
- Credentialing documentation
- Facility credentialing
- Credential verification
- Microsoft office
- Training and mentoring
- Analytical and critical thinking
- Conflict resolution
Certification
- Certified Physician Licensing Specialist
Timeline
Senior Credentialing Specialist
USA Radiology Management Solutions, LLC
10.2020 - Current
Medical Assistant II
Mercy
01.2020 - 10.2020
Practice Manager
Katalyst Pain Management and Treatment Center
05.2014 - 12.2019
Certified Physician Licensing Specialist - Medical Licensing
Team Med Global
Graduate Certificate - Medical Assisting
Midwest Institute
High School Diploma -
Francis Howell High School
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