Karen Stanley

Karen Stanley



Meeting Minutes

Windows, Mac and Linux Computer Systems

Windows operating system daily use. Ability to work in Mac and Linux operating system environments.

Customer Service

Microsoft Office

Extensive use of Microsoft office, Word, Excel and Power Point Outlook Email and Calendar Compose business correspondence  Set up and use of data bases Power Point slide creation

Work History

Work History
Nov 2012 - Present

Credentialing Coordinator/Provider Enrollment

Zotec Partners (Formerly Medical Management Professionals)
  • Troubleshoot medical insurance claims that are denied by multiple companies, responsible for over $285,000 in denied insurance claims being paid to clients in 2013 and 2014.

  • Designed and implemented Provider Credentialing Packet for execution of provider enrollment and hospital privileges, increasing productivity and ensuring provider participation in a timely manner.

  • Liaison between customer service representatives and government/commercial insurance departments regarding payment and provider information.

  • Initiate new client set up, including system updates, notification to insurance payors, hospital appointments, facility and provider credentialing. Assemble information to complete provider enrollment applications and ensure participation in government and commercial insurance plans. Hospital and insurance payor recredentialing for group practices and individual providers.

  • Track pending applications, contracts and agreements. Maintain physician information in credentialing software.

  • Perform administrative tasks including typing correspondence, filing, and data entry.

  • Maintain confidentiality of physician information, coordinate work with physician office staff.

Aug 2011 - Apr 2012

Staffing Coordinator

Kindred Hospital
  • Initial set up of computerized staffing system, including staffing software, excel spreadsheets resulting in consistent nurse to patient ratios.

  • Responsible for ensuring proper nurse staffing levels for all shifts for ICU, Med/Surg, and maintaining appropriate certified nurse’s aides staff levels.

  • Maintain nursing department staffing records including master schedule, cancellation list and attendance records, American Heart Association BLS and ACLS certifications.

  • Maintain employee skills test information, annual hospital updates and other educational competencies.

  • Maintain accuracy of nursing payroll for staff of 130.

  • Maintain temporary nursing staffing agency competencies, orientation and billing records.

  • On boarding for new nursing staff members and temporary employees.

Nov 2010 - Apr 2011

Enrollment and Eligibility Specialist

John Petersmith Hospital
  • Approved patients for JPS Connection, refered completed cases to TDHS 
  • Assisted patients in completion of program applications and other paperwork.
  • Ensured that all program applications submitted to TDHS were complete with supporting documentation attached.
  • Followed through with patients notifying them of further information required to complete or to inform them of status of eligibility determination.
  • Input and updated data in the SMS and eligibility determination system.
  • Maintained a minimal error rate in accordance with established guidelines.
  • Obtained all necessary demographic and clinical information required to properly determine potential program eligibility.
  • Participated in continuous quality improvement activities benefiting the department and the Network.
  • Received, processed, and provided follow-up on enrollment packets received to ascertain the potential for JPS Connection eligibility and/or other programs.
Aug 2008 - May 2010

Credentialing Coordinator/Provider Enrollment

University of North Texas Health Science Center
  • Initiated Medicare and Medicaid provider enrollment applications, revalidations and provider changes for 200 plus group practice with high turnover.

  • Developed and maintained enrollment progress and provider number databases for department managers, developed new application process for new applicants.

  • Ensured Medicare /Medicaid compliance regulations were adhered to in regards to provider enrollment.

  • Appointed to Credentialing Task force, and Human Resources Classification Committee.

Jun 2006 - Jul 2008

Credentialing Coordinator

University of North Texas Health Science Center
  • Verified that physician and allied health staff had the proper credentials to work in each medical discipline according to Medicare and Joint Commission guidelines.

  • Responsible for researching and verifying medical school transcripts, prior employment, personal and professional references and professional liability insurance history.

  • Detailed knowledge of Joint Commission, CMS, state and federal laws regarding accreditation standards

  • Maintained, reviewed and updated policies as needed.

  •  Appointed to Human Resources Classification Committee.

Mar 2003 - May 2006

Administrative Assistant

University of North Texas Health Science Center
  • Greeting office visitors, responded to patient complaints, and assisted director with staff issues.

  • Collaborated with director to design and implement report card style quality report for clinics, including tracking and reporting type of complaints per department.

  • General office duties, filing typing, answering phones, ordering and maintaining sufficient office supplies, and travel arrangements.

  • Tracked department budget and operating expenses, reported time and attendance in PeopleSoft.

  • Sorted incoming and outgoing mail.

  • Set up executive meetings, prepared agendas, taking minutes, ordered food and electronic equipment.

  • Presented Infection Control and Abuse/Neglect information for University New Employee Orientation, appointed to Human Resources Classification Committee.