Autumn Pegues

Managing the PSV process for all healthcare professionals (physicians, dentists, nursing, allied health). This includes reviewing applications for completion, verifying state licensure, collecting information contained in the NPDB, and collecting information from the Health Care Integrity and Protection Databank.ank.

• Implementing USAR policies and standards to ensure that credentialing operations are complying.
• Working with applicants and USAR staff to support and enhance credentialing functions.
• Compiling all documents, building credential review files for review by the Centralized Credentials Privileging Board, and documenting results.
• Generating and emailing notification letters of credentialing results to applicants and/or responding to questions from applicants regarding status of credentialing.
• Data entry into CCQAS as the official system of record.
• Prepare, notate, and maintain reports of employees based on accreditation, education, facility privileges, experience, membership, and licensure, ensuring all employee information meets federal, state, and local guidelines.
• Maintain regular written and verbal correspondence with agencies, hospitals, malpractice carriers and medical review boards.

• Reviews and screens initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state, local, and University regulations, guidelines, policies, and standards. Maintain records of submitted applications, documents, approval/termination letters, and revalidation/ re-credential letters pertaining to assigned providers' enrollment. Evaluate information on applications to verify completeness and accuracy before submitting. Conducts primary source verification, collects and validates documents to ensure accuracy of all credentialing elements; assesses completeness of information and qualifications relative to credentialing standards and UNM Health System criteria. Troubleshoot any enrollment or profile issues that arise for assigned providers. Ensure all applications are submitted for various payers requiring submission before the first date of service. Utilizing systems such as CAQH, Commercial Payor Provider Portals, EPIC, GAMMIS, MSOW, VERITY, NPPES and DEA Registry, PECOS, and other PTAN Request tools. Execute follow ups to the Provider’s as neeKeep the supervisor abreast of any credentialing and enrollment issues, which may affect a provider’s revenue.enue. Working closely with The Revenue Cycle department. Review accuracy of invoice details including customer/self pay billing. Execution of special projects for the Revenue Cycle Team. Manage various work queues for accuracy of claims before routing to insurance companies.

• Compiled, sorted, and filed applications received. Computer and systems literate. Possess willingness to learn and develop understanding of configuration best practices. Manage multiple tasks with minimal leadership supervision. Have a clear understanding about the Georgia Medicaid and Medicare Program (CMS) to adhere to service level agreements. Update and maintain provider files including documenting service locations, license numbers, Social Security numbers, DEA numbers, NPI numbers. Enter data, while confirming and logging provider’s credentials. Prepare CVO and non-CVO applications for third party processing.

• Cared for physically disabled and mentally unable patients who cannot support themselves. Assist with daily activities including but not limited to the home and facility setting. Assisted with travel needs. Measured and document all vitals as needed or when appropriate. Practice all safety measures and disease control procedures. Administered medications given by Registered Nurse per shift, while documenting intake and any adverse reactions.