Denise Greene

Managed office operations including reservations, phone communication, and payment collection. Successfully transitioned office systems from paper-based to electronic, performing essential data entry tasks.

Responsible for data entry processes supporting healthcare providers. Assisted providers in obtaining hospital privileges and completing insurance enrollment procedures.

Managed day-to-day operations for physician credentialing and privileges, reducing costs by utilizing in-house locums physicians. Collaborated with the Quality Department on standards like OPPE, FPPE, QRS, and Joint Commission surveys. Led the migration from Priv-Plus to Cactus Software and managed medical staff meetings and physician office interactions.

Supervised front office operations, including preparing and submitting physician application paperwork to hospitals and insurance companies. Managed communication with clients regarding application status and coordinated travel, training, and HR for physicians and staff. Responsible for scheduling physician call rotations.

Managed the daily credentialing and recredentialing processes for physicians across eight hospitals and three surgery centers. Ensured compliance with system-wide standards for provider eligibility.

Handled physician appointments and reappointments, attending medical staff and peer review meetings. Prepared monthly call schedules and facilitated communication between physician offices and hospital departments.

Managed daily office operations and performed credentialing for IPAs, adhering to NCQA standards and presenting documentation to committees. Developed and amended policies and procedures for compliance. Facilitated physician enrollment with insurance companies and hospitals.

Supervised and performed daily credentialing and recredentialing activities for multiple IPAs. Attended credentialing committee meetings and revised policies and procedures to ensure NCQA compliance.

Supervised daily credentialing and recredentialing operations, ensuring compliance with CIGNA and NCQA standards. Conducted audits of delegated entities and developed policies and procedures for committee approval.

Conducted audits of both internal and delegated entities to ensure compliance with NCQA and Prudential standards. Developed measures and guidelines to support compliance efforts within the credentialing department and delegated entities.

Managed pre-screening processes for specific Texas regions and initiated a new network in West Texas. Prepared agendas and attended committee meetings, handled application mailings, and tracked statuses. Collaborated with the QI department and prepared documentation for the 1997 NCQA audit.