JEAN PIOLET

117 E. Bancroft Drive

Garland, TX 75040

E-mail address:

OBJECTIVE

Credentialing Specialist/Coordinator position in a group practice or managed care setting.

SUMMARY OF QUALIFICATIONS

• Effective interaction with customers and all levels of management.

• Computer literate; working knowledge of MS Word, Excel, Outlook and Lotus notes.

• Functions well individually or as a team member.

• Keyboarding 40+ wpm.

• Ability to prioritize and multi task.

• Good customer service skills.

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WORK EXPERIENCE

PSR Healthcare Group Dallas, TX

Credentialing Specialist 9/09 to present

• Provides support to clients by assisting practitioners and mid-level providers

with all aspects of the credentialing/privileging process.

• Submit application for enrollments in third party payor contracts and follow up with billing company on behalf of the providers until billing numbers have been issued.

• Monitor and manage licensure/certification reports.

• Request, assist, and follow up on missing information needed by the MSO to complete the privileging process.

• Obtain annual insurance renewals from the insurance company for all providers associated within our client groups.

• Verify provider credentials using on-line resources and note any adverse actions for review by manager.

• Provide weekly report of status of the enrollment and privileging process and determine any problem that might prevent the practitioner from being scheduled to work on time.

• Facilitate reappointment process.

The Schumacher Group Dallas, TX

Sr. Medical Staff Liasion 6/08 to 8/09

• Facilitated the procurement of provider documents required to associate him/her with a Schumacher Group client hospital, including the hospital medical staff application, abbreviated provider enrollment packet and provider agreements.

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• Referenced and researched the provider’s background before presenting to the hospital client for privileges.

• Served as the Medical Staff Liaison to The Schumacher Group hospital account on behalf of the provider.

• Coordinated with Provider Enrollment by providing the necessary documents to successfully enroll providers in third party payor contracts.

• Requested malpractice insurance certificate from carrier for each facility where physician will be assigned.

• Obtained written documentation on any disciplinary actions noted on application from the appropriate agency.

• Performed primary source verifications and run queries of the National Practitioner Data Bank, Texas State Medical Board, and various specialty boards.

• Facilitated the privileging process and presented the provider’s application to hospital for consideration of privileges.

• Responsible for tracking the application process until approval has been granted at each facility and provide written report to appropriate department.

• Monitored licensure/certification and reappointment expiration reports to ensure providers were working within hospital compliance.

• Responded quickly to hospital’s need at all times, particularly as they underwent Joint Commission and Medicare audits.

• Accurately keyed all new physician data into credentialing database.

Concentra Health Addison, TX

Credentialing Specialist 10/07 to 3/08

• Credentialed Concentra Urgent Care facilities for existing and new payor contracts.

• Coordinated with the Area Administrators/Field officers to ensure timely receipt of requested documents.

• Ensure that all expiring credentialing documents were updated.

• Processed new NPI numbers for providers, organizations, and facilities.

• Ran primary source verifications of the National Provider Data Bank and State License Boards to determine any adverse activity on all potential Concentra applicants as well as contracted clinicians.

• Created and audited files.

• Maintained and updated credentialing spreadsheets.

• Data entered applications and scanned all credentialing documents into the credentialing system.

• Processed and reviewed provider applications for completeness and requested any additional documents needed.

• Submitted completed files to the CVO for committee review and approval.

• Faxing, copying, scanning and other duties as required.

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Pinnacle Anesthesia Consultants, P.A. Dallas, TX

Credentialing Coordinator 3/06 to 10/07

• Responsible for the initials, add-ons, and reappointment of medical staff and allied health professionals within the anesthesia group.

• Served as the point person for the physician recruiter.

• Facilitated the initial process for both internal and external credentialing and delineation of privileges of all medical staff and allied health care providers.

• Coordinated with the insurance company to ensure timely issuance of malpractice insurance coverage for new hires.

• Processed initial and reappointment applications for the managed care health plans.

• Performed background checks and credit reports on new professional staff and allied health care professionals.

• Gathered primary source verifications using on-line queries and written correspondences.

• Updated and maintained the credentialing data base as necessary.

• Generated letters and reports; prepared and mailed credentialing packets.

• Followed up on missing information and requested expired credentialing documents

• Scanned documents, copying, faxing filing; other duties as assigned.

Health Partners of/Midwest (contract/pt. time) St. Louis, MO

Credentialing Assistant 10/04 to 12/05

• Assisted the credentialing Department with all aspects of the credentialing process.

• Input data from applications into the credentialing system.

• Updated provider information as needed.

• Assisted with the gathering and updating of expired documents.

• Mailed out credentialing packets to providers and followed up on missing information required to complete the files.

• Assisted coordinators with primary source verifications.

• Created new files and maintained the department’s filing system.

Baylor Regional Medical Center @ Grapevine Grapevine, TX

Medical Staff Coordinator 8/03 to 4/04

• Responsible and accountable for the initial appointment/reappointment and delineation of privileging of the medical staff and allied health professionals.

• Worked with the department chiefs and committee chairmen in preparing the files for credentials committee.

• Generated monthly credentialing reports and updated licensure and malpractice insurance as needed.

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• Verified the background, education, and experience of medical staff and allied

health professionals according to NCQA and JCAHO compliance. .

• Reviewed applications for completeness and requested missing information needed to complete the file.

• Data input of all initial applications and set up new files.

• Generated letters and prepared credentialing packets for mail out.

Sweetwater Health Enterprises (CVO) Addison, TX

Credentialing Coordinator 4/01 to 4/03

• Reviewed applications for completeness and requested any missing credentialing documents needed to complete the files.

• Input and maintain data in the credentialing data base.

• Generated weekly aging file reports, audit files for committee meetings.

• Verified Background, education and experience of providers and noted any adverse action or malpractice cases for review.

• Audit files in preparation for the credentials committee.

• Filing, faxing, answer phones.

• Monitor and updated expired licensure/certifications.

Protective Dental Care Dallas, TX

Credentialing Coordinator 11/99 to 4/01

• Processed applications for providers applying to the Protective Dental Plan.

• Maintained spreadsheets of new network providers and updated demographics information as needed.

• Audited and prepared files for quarterly credentials committee meetings.

• Verified primary source credentials and reported any adverse findings by the state regulatory boards to the department manager for review.

• Gathered missing information and expired documents from providers.

• Prepared initial and reappointment packets for mail outs.

• Reviewed applications for correctness and completeness

• Data entered applications into the credentialing database.

Credentialing Verification Center Irving, TX

Credentialing Specialist 6/96 to 10/98

• Responsible for the timely processing of hospital applications for privileges of medical staff and allied health professionals.

• Prepared re-credentialing packets and mailed to providers.

• Reviewed applications and requested missing/expired documents.

• Run on-line verifications of provider’s licensure, including query of the National Practitioner Data bank.

• Input and maintain the credentialing database.

• Maintained the credentialing database as needed