Open to opportunities

Marlene Joyce

@marlenejoyce

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Credentialing expert with 25 years of healthcare management experience.

United States

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What I'm looking for

I am looking for a role that values my extensive healthcare expertise and offers opportunities for growth.

I am a dedicated Credentialing Manager with over 25 years of experience in healthcare management, specializing in multi-state Medicaid MCO credentialing and contracting. My extensive background has equipped me with a comprehensive understanding of the healthcare landscape, allowing me to effectively manage the credentialing and payer enrollment processes for over 40 locations across seven states. I pride myself on my strong communication skills and critical thinking abilities, which have been instrumental in driving organizational success.

Throughout my career, I have demonstrated accountability and independence, particularly in remote work environments. My role at SaVida Health has involved initiating negotiations with various payers, maintaining provider files, and ensuring compliance with NCQA guidelines. I have a proven track record of identifying trends and creating action plans for improvement, all while collaborating cross-functionally with various departments to ensure smooth onboarding of providers.

Prior to my current position, I successfully managed a private practice, overseeing all aspects of licensing, credentialing, and contracting. My experience includes coding, billing, and patient coordination, which has further honed my ability to navigate the complexities of the healthcare system. I am passionate about leveraging my expertise to contribute to an organization that values comprehensive knowledge and a commitment to excellence in healthcare.

Experience

Work history, roles, and key accomplishments

Current

Credentialing Manager

Current

SaVida Health, PC

Sep 2019 - Present (5 years 9 months)

Managed end-to-end credentialing and payer enrollment for over 40 multi-state locations, ensuring compliance with NCQA guidelines. Negotiated contracts with commercial, Medicare, and Medicaid payers, and maintained accurate provider profiles across various databases.

Credentialing Payer Enrollment Contract Negotiation NCQA Guidelines CAQH Revenue Cycle Management Database Management Compliance Monitoring

Contact Center Specialist II/Revenue Cycle

University of Pittsburgh Medical Center Corporate Services

May 2015 - Present (10 years 1 month)

Provided outstanding customer service in a high-volume call center, triaging patient calls and collaborating with medical staff. Utilized strong communication and stress management skills to handle high-risk patient issues and gather pertinent information for ER triage.

Customer Service Call Center Operations Patient Triaging Communication Skills Data Collection

Practice Manager/Administrative Coordinator

Eileen Rice, M.D. Neurology, Inc.

Jan 1993 - Present (32 years 5 months)

Successfully managed a profitable private neurology practice, overseeing all aspects of licensing, credentialing, and contracting. Responsibilities included medical coding, billing, patient care coordination, and maintaining physician schedules and hospital re-appointments.

Credentialing Medical Billing Medical Coding Patient Care Coordination

Medical Coordinator

Neurological-Neurosurgical Associates

Jan 1983 - Present (42 years 5 months)

Assisted physicians with in-office testing and outpatient procedures, managing all back-office duties. Responsibilities included charting patient visits, coding and billing for all charges, and obtaining prior authorizations for medications and procedures.

Medical Coding Billing Office Management

Education

Degrees, certifications, and relevant coursework

Pittsburgh Technical College

Certificate, Medical Coding

Completed a certificate program in Medical Coding, gaining specialized knowledge in healthcare classification systems and coding standards.

The Median School of Allied Health Careers

Diploma, Medical Assisting

Activities and societies: American Association of Medical Assistants (AAMA) Certificate

Obtained a Diploma in Medical Assisting, which included comprehensive training in clinical and administrative tasks within a healthcare setting. Certified by the American Association of Medical Assistants (AAMA).