a-russell-resume-2-2018%20 BAy.docx - Alisha Russell Katy TX 77449| 832-773-2212 \u2502 [email protected] | LinkedIn Healthcare Operations

a-russell-resume-2-2018%20 BAy.docx - Alisha Russell Katy...

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Alisha Russell Katy, TX 77449| 832-773-2212 │ [email protected] | LinkedIn Healthcare Operations Professional Skilled and highly-trained healthcare professional, with considerable experience managing credentialing, staffing, and patient account functions in diverse medical service environments. Strategic, analytical, and collaborative, with numerous awards and recognitions, and an impeccable history of compliance with regulatory requirements and operational protocols. AREAS OF EXPERTISE Medical Staff Recruiting & Hiring Insurance Claim Processes Cactus Credentialing Database Six Sigma Black Belt Payroll reconciliation Post/Grant Award Mgmt. Reimbursement Mgmt. Credential Assessments & Approvals Joint Commission, NCQA, URAC & CMS Regulatory Compliance & Audits EPIC Systems Trainer Expense ledger reconciliation Department Budgeting Fiscal Budget Mgmt. Staff Supervision & Leadership Health Care Quality Improvement Act Medicaid and Medicare Programs Performance Assessments & Discipline Budgetdevelopment/management and forecasting Review Budget/ PROFESSIONAL EXPERIENCE SR. ASSOCIATE MGR /CREDENTIALING MGR| Baylor College of Medicine, Houston, TX 2016 to Present Coordinate reviews and verifications of practitioner applications in accordance with rigorous approval and vetting standards. Thoroughly analyze application documents, conduct extensive background investigations, validate any discrepancies, and identify issues requiring additional investigation and evaluation. Prepare credential files for presentation to the Health System entity, utilize the Cactus credentialing database to perform queries and prepare reports, and facilitate managed care delegated credentialing audits and process requests for clinical privileges under strict guidelines. Oversee the initial, reappointment and expired credential processes for all medical staff, Allied Health Professional staff, other Health Professional staff, and delegated providers, ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state), as well as Medical Staff Bylaws, Rules and Regulations, policies and procedures, and delegated contracts. Monitors grant account spending activity, and reconcile with proposed budget, award restrictions, and actual expenses. Serves as the primary contact for the CPRIT MIRA grant. Provides guidance and direction to the principal investigators in submitting programmatic, financial and other change requests in a timely manner in compliance with funding agency specifications. Generates monthly financial reports, discuss spending trends with faculty, and makes recommendations as needed. Processes various financial transactions
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  • Spring '18

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