Michele Oxford CPCS

Experience

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  Premera/LifeWise Health Plans

  Dec 2002 - Sept 2016

  • Delegated Credentialing Administrator

    Dec 2006 - Sept 2016

  • Credentialing Specialist

    Dec 2002 - Dec 2006
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  Cigna-HealthSpring

  Sept 2016 - Apr 2017

  Compliance Speicalist

  Responsible for ensuring compliance with governmental and internal requirements. Facilitates the development and implementation of compliance policies and procedures. Able to research compliance issues and recommend changes that support compliance with CMS and State contract obligations. Establishes and maintains relationships with business owners. May coordinate site visits with external regulators. Coordinate and assists in leading the implementation and of corrective action plans by providing compliance oversight and guidance, as needed. Show less

• 

  CHI Franciscan Health

  Apr 2018 - Jan 2019

  Credentialing Specialist

  Performed the provider credentialing and database maintenance processes based on department and organizational policy and, procedures and the standards of guidelines set forth by Medicare/Medicaid (CMS), The Joint Commission (TJC), National Committee for Quality Assurance (NCQA), URAC, State and Federal Government, and the health plan payors.

• 

  UnitedHealth Group

  Jan 2019 - now

  Delegated Credentialing Account Manager

  Responsible for managing the end to end oversight responsibilities for delegated credentialing. Which includes but not limited to: ongoing relations, communications and education of the delegated group and oversight audits for compliance with UnitedHealthcare, NCQA, State and Federal credentialing requirements. Driving a consistent and efficient process to support the management of all delegated audit activities, problem resolution, defining and recommending action items for the delegated group. Evaluating outcomes and providing ongoing feedback to the appropriate delegate and internal staff/committees and providing support at Regulatory and Accreditation surveys. Show less