About
With over 25 years in the Credentialing and Healthcare business, I understand the challenges and headaches a provider goes through to become a participating provider with a health plan, hospital and the Medicaid network. As a former Credentialing Manager and an expert in health plan credentialing, I’m able to eliminate the credentialing and re-credentialing challenges and the delay in becoming a provider in a health network, hospital and the Medicaid plan. My goal is to accommodate medical providers with a pleasant credentialing and enrollment process that results in rapid reimbursements from the managed care organizations.
NCQA and URAC
With experience working with National Committee for Quality Assurance (NCQA) and Utilization Review Accreditation Commission (URAC) for over 20 years, I will bring my knowledge and best practice experience in the credentialing and re-credentialing and quality improvements processes.
Delegation
As health care systems grow larger more providers are being credentialed with Health Plan Organizations under what is known as Delegated Credentialing. This is a process where a health plan organization gives authorization to the provider group to perform credentialing in-house. If your organization are looking into participating as Delegated Group with a Health Plan Organization, I can assist you with the complete process. As a former Credentialing Manager, I created the credentialing delegation program for a large managed care organization and have the experience and knowledge of Delegated Credentialing.
NCQA and URAC
With experience working with National Committee for Quality Assurance (NCQA) and Utilization Review Accreditation Commission (URAC) for over 20 years, I will bring my knowledge and best practice experience in the credentialing and re-credentialing and quality improvements processes.
Delegation
As health care systems grow larger more providers are being credentialed with Health Plan Organizations under what is known as Delegated Credentialing. This is a process where a health plan organization gives authorization to the provider group to perform credentialing in-house. If your organization are looking into participating as Delegated Group with a Health Plan Organization, I can assist you with the complete process. As a former Credentialing Manager, I created the credentialing delegation program for a large managed care organization and have the experience and knowledge of Delegated Credentialing.
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Gloria Kelly
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