LaQuesha Loville

Responsibility for the credentialing of new appointments and re-appointments of the Employed Physicians and Advance Practice Clinician of Ochsner Health System. Complies with strict guidelines and standards set by JCAHO, CMS and contractual agreements with health care providers. Assumes responsibility for Administration and Medical Legal aspects for employed Ochsner physicians. Coordinates committee meetings and performs administrative functions as an ASST to the Director of Medical Staff Services. Performs credentialing process. Maintains credentialing database. Performs general administrative duties. Performs medical staff liaison duties. Performs special assignments as required. Other duties as assigned. Document, maintain and crosscheck client credentials in multiple databases, including CAQH and other third-party databases, as applicable. Create, update and track provider information in the internal credentialing system to ensure that credentials are completed timely and correctly.

Answer client questions in reference to their taxes. Collect documentation to support any tax credits/ deductions on accounts. Provide tax quotes to all clients needing help with account, insurance breaks, tax information. Scheduling one on one appointment for tax consultations, and verifying all information/ documents provided to stay clear of any audits by IRS.

Lead continuous improvement initiatives, optimizing efficiency and precision in the credentialing process. Collaborate cross-functionally to streamline processes and implement best practices. Ensure seamless on boarding of new providers, meticulously verifying all required credentials prior to approval. Coordinate with providers to collect missing documentation, ensuring initial credentialing and re-credentialing applications are done timely while following up with providers regarding enrollment applications. Conduct rigorous audit verification of healthcare provider credentials, licenses, certifications, DEA, CLIA and affiliations to ensure network participation eligibility. Perform ongoing monitoring of provider credentials, initiating re-credentialing as required for compliance. Conduct internal audits on credential files, ensuring accuracy and adherence to standards for the committee. Stay informed about industry regulations, accreditation standards, and organizational policies to ensure compliance.

Responsible for credentialing activities as it relates to initial credentialing, re-credentialing, and credentials modification. Tracking of issues associated with activities necessary to maintain and document ongoing compliance with CPC policy. Will be expected to assist with other tasks/projects as requested. Compliance with HCA policy and procedure, Federal and State regulatory and accrediting agencies is required. Manual entry of practitioner data, Review of practitioner data, assist in verifying data, Primary Source Verification of select items, Input on performance improvement for processes and documents, assist with scheduling meeting, clerical support and other duties as requested Receive requests for application review for completeness of information, identify deficiencies. Monitoring and maintain credentialing in accordance with CPC policy and procedure, Joint Commission standards, URAC, State and Federal Regulatory regulations. This will include but not limited to the following verifications: National Practitioner Data Bank OIG/GSA for Medicare/Medicaid exemption DEA Verification License Board Certification. Prepare credentialing and re-credentialing applications for process review. Assure timeliness of process completion and confidentiality of data. Ensure that all credentials’ files are current and complete pursuant to expiration date of medical licenses, board certifications, professional-liability insurance coverage, DEA and other pertinent information, per CPC policy. Maintain high quality, timely and accurate credentialing processes of medical and allied healthcare professionals per CPC policy.

This will include but not limited to the following verifications: National Practitioner Data Bank OIG/GSA for Medicare/Medicaid exemption DEA Verification License Board Certification.

Input patient data into system through EMR and health Strems. Register patients in labor and delivery department. Verified primaries, secondary and third parties’ insurance. Stock the rooms for patient, babies’ supplies. Assist with vitals for postpartum patients. Help in NICU with feedings, weights and changing babies. Making badges for patients, family members and visitors for labor and delivery floor. Also assisting postpartum patients and staff members with floor duties.

Schedule and cancel appointments for patients at the rheumatologist on BAFB for (multiple clinics.) Coordinates in a professional and courteous manner with patients and clinic staff to resolve patient issues and concerns. Provide an explanation of TRI CARE benefits, and answer questions regarding enrollment, portability. Input telephone consults in computer system called CHCS to the physician enabling patients/ provide contact on medical issues and concerns. Verify patient eligibility confirm TRI CARE status in CRIS, and update patient demographics in CHCS. Approve timecards, leave, and records. Performed data entry, answered the phones, set appointments, and performed filing duties. Responsible for ensuring that the reports for medical billing were documented, accurate and reported in a timely matter. Verified multiple primaries, secondary and third parties’ insurance, also maintained daily logs, worked in the e-clinical works system for medical records. Schedule and canceled appointments for patients for (multiple) modlities like Bone density, Mammo, MRI, Flouro, CT, US, X-RAYS etc.