JESSICA M. LANGFORD

- Evaluated and processed enrollment applications to ensure compliance with state and federal requirements.

- Cross-checked provider information against state and national databases.

- Analyzed and identified anomalies in enrollment applications.

- Monitored and ensured ongoing compliance with Medicaid policies.

- Maintained accurate records of provider enrollment activities.

• Functions as a liaison between hospital administration and the Medical Staff
• The Coordinator acts independently and maintains strict confidentiality of patient, hospital and medical staff information
• This individual oversees credentialing and privileging activities and independently coordinates their own work, prioritizing according to the workflow of the office and established or necessary deadlines
• As the workload in this office is heavy, assessing priorities is constant in order to meet deadlines

• Company Overview: Enterprise Credentialing Coordinator for BlueCross BlueShield of Illinois, Montana, New Mexico, Oklahoma, and Texas, Remote
• Responsible for coordinating, monitoring, and maintaining the credentialing process while supporting department initiatives and projects
• Ensures that all internal and external providers have the appropriate certifications, licenses, or credentials to practice
• Tracks onboarding paperwork and applications to and from providers; reviews materials for accuracy
• Monitors and notifies providers of upcoming expiring certifications
• Maintains and updates continuing medical education credits and other training requirements
• Maintains and updates the credentialing database as needed for provider information, credential changes or renewals
• Enterprise Credentialing Coordinator for BlueCross BlueShield of Illinois, Montana, New Mexico, Oklahoma, and Texas, Remote

• Company Overview: Enterprise Quality Control Specialist for BlueCross BlueShield of Illinois, Montana, New Mexico, Oklahoma, and Texas
• Ensure professional providers applying for initial or ongoing network participation are credentialed or recredentialed in a timely and appropriate manner for presentation to the medical director
• Prepare all documents and correspondence for professional providers with issues for presentation to the BCBSNM & BCBSMT bi-monthly credentialing committees; ensure documentation for those providers approved for network participation is current at time of the committee determination
• Scheduling and maintaining all Credentialing Committee meetings for BCBSNM & BCBSMT
• Implement credentialing processes to ensure NCQA and URAC accreditation is maintained for BCBS of NM and MT
• Monthly monitoring of ongoing NM and MT state boards for license and adverse actions
• Oversight and implementation of essential credentialing functions to attain and maintain quality providers in the network
• Conducted credentialing audits as well as monitoring network data quality
• Utilized knowledge of credentialing policies and procedures per NCQA, URAC and CMS standards and other regulatory requirements
• Served as a liaison to delegated entities and vendors to ensure current and adequate credentialing process were in place
• Developed and performed queries for reporting purposes
• Monitored and helped maintain credentialing and re-credentialing policies and programs as well as state and federal requirements to ensure compliance was met
• Enterprise Quality Control Specialist for BlueCross BlueShield of Illinois, Montana, New Mexico, Oklahoma, and Texas

• Assisted with the resolution of claims, pricing and contract issues
• Coordinated with internal departments to evaluate and resolve provider/contract and service issues
• Handled more complex issues and trained/mentored staff

• Company Overview: Enterprise Quality Control Specialist for BlueCross BlueShield of Illinois, Montana, New Mexico, Oklahoma, and Texas
• Oversight and implementation of essential credentialing functions to attain and maintain quality providers in the network
• Conducted credentialing audits as well as monitoring network data quality
• Utilized knowledge of credentialing policies and procedures per NCQA, URAC and CMS standards and other regulatory requirements
• Served as a liaison to delegated entities and vendors to ensure current and adequate credentialing process were in place
• Developed and performed queries for reporting purposes
• Monitored and helped maintain credentialing and re-credentialing policies and programs as well as state and federal requirements to ensure compliance was met
• Enterprise Quality Control Specialist for BlueCross BlueShield of Illinois, Montana, New Mexico, Oklahoma, and Texas