Sara Ferguson Email & Phone Number

Golden Valley, Minnesota

Responsible for managing the credentialing, privileging, and provider enrollment process for all practitioners practicing within the Infinite Health Collaborative, PA (I-Health) clinics under NCQA guidelines and Ambulatory Surgery Centers (ASC’s) under AAAHC guidelines. This includes overseeing the initial credentialing process for new practitioners, re-credentialing for current practitioners, and maintaining and updating practitioner files to ensure compliance with accrediting and regulatory bodies as well as overseeing the provider enrollment process for new and current practitioners. Also serve as a resource for practitioners and staff on credentialing and privileging-related matters and will work closely with other departments to ensure the smooth operation of the credentialing process.KEY ACHIEVEMENTSAchieving NCQA CR accreditation for Infinite Health Collaborative, PAPresently engaged in obtaining NCQA CVO accreditation for Revo HealthExecuted the integration of a new credentialing database allowing us to become completely paperlessUndertook and assumed Ambulatory Surgery Center (ASC) credentialing for five ASC'sFacilitated over 15 clinic integrations into our group practiceAchieving and maintaining delegated contracts with payers

Greater Minneapolis-St. Paul Area

Manages daily internal operational functions of the FSCO.Manages the work of the Reappts Team, NCQA Team, Expirables Team, and Admin Assistant.Manages work flow, staffing responsibilities and allocation of staff resources to meet entity expectations and accreditation standards.Ensures optimal staff performance through monitor mechanisms.Assure compliance with applicable regulatory standards including NCQA, CMS and TJC.Serve as a Liaison and maintain relationships with key departments.

Greater Minneapolis-St. Paul Area

Supervises the Joint Commission Initial and Reappointment Credentialing SpecialistsAssures timely completion of applications to meet goalsAssures ongoing training to assist staff in achieving quality goalsCoordinates work assignmentsAssists with urgent needs for processing or quality reviews

Greater Minneapolis-St. Paul Area

Assists in all areas of the credentialing department and works with team members to address questions regarding processing of fileProcesses red flag issuesPerforms Quality ReviewsAssists in training team membersParticipates in performance improvement processes and implementation of changes.

Greater Minneapolis-St. Paul Area

Processes reappointment applications including verifying reappointment data changes, performs primary source verification of license, insurance, DEA and board certification, running NPDB, EPLS, process privilege forms, sends reference letters, sends hospital verification letters,Ensure all JC and NCQA standards are met while processing applicationsIdentifies red flag issues and works with Lead to resolve issues of concernPerforms reviews of files/privilege requests, enters privileges into e-Delineate Sends completed applications to the Medical Staff Offices

Hendersonville, Tn

Process Outlier/High dollar accounts for HCA facilities being billed to MedicareResolve issues for DRG benefits exhaust high dollar accounts Verifies payment will be received by Medicare for HCA FacilitiesMaintain contact with facilities to verify all coding is correctOnce payment has been received issuing remaining balance to secondary payorsMultitasking and working on several systems at once to exceed productivity levelsFollow and maintain HIPPA regulationsReceived top performer award Mentor for new employees to assist in the training and learning of billing department

Eden Prairie, Mn

Initial position Gap Claims Filing/Post Gap Processor for GMACProvide customer service through phone, e-mail, and standard mail Contact with insurance companies to verify all claims process complete Quality and accuracy review of all claims to finalize and closeTermination of customer leases for GMAC and Nissan CanadaRe-Initiate billing cycle for customers or approving and issuing refund checks Invoicing month ending billing statements for GMAC, Nissan Canada, and Capital One Auto Finance Process daily and weekly reports of total claims volume for GMAC and Nissan Canada Training new employeesAssisting co-workers with issues on claims and managers with special projects Stand in for leads when time off was needed

Bachelor'S Degree, Healthcare Management

Associate'S Degree, Business Management