Heidi Praught
Monticello
Summary
With a robust background at Optum Services, I excel in credentialing management and team leadership, ensuring regulatory compliance and operational efficiency. Spearheaded quality assurance initiatives, achieving significant process improvements. My proactive approach and ability to drive excellence in provider enrollment and data integrity have consistently enhanced organizational performance.
Overview
18
18
years of professional experience
Work History
Delegated Credentialing Specialist
Optum Services
Eden Prairie
05.2019 - 01.2025
- Participated in periodic audits of credentialing files to maintain compliance with applicable regulations and policies.
- Assisted in developing and implementing departmental procedures related to provider enrollment and maintenance activities.
- Interacted regularly with representatives from health plans and commercial payers regarding credentialing matters.
- Attended meetings and seminars related to healthcare industry regulations and trends.
- Served as a resource person for staff members seeking assistance in understanding complex regulatory requirements related to provider enrollment processes.
- Participated actively in special projects or initiatives pertaining to improvement of operational efficiency within the department.
- Collaborated with legal department to ensure compliance with federal and state regulations.
- Managed end-to-end provider credentialing process, ensuring compliance with industry standards.
Provider Data Management Supervisor
Optum Services
Eden Prairie
03.2016 - 06.2019
- Prepared weekly reports summarizing departmental operations and progress against goals.
- Conducted performance reviews, coaching, and disciplinary action as needed.
- Collaborated with other departments to streamline processes and improve efficiency.
- Managed staff of 25 employees, ensuring adherence to company policies and procedures.
- Identified process improvements that could be made in order to increase productivity.
- Resolved client issues by delivering excellent customer service and maintaining positive attitude.
- Implemented quality control measures to uphold company standards.
Credentialing Quality Assurance Supervisor
Optum Services
Eden Prairie
03.2011 - 03.2016
- Provided guidance to staff on best practices in quality assurance methods.
- Conducted regular audits to ensure compliance with quality standards.
- Participated in internal and external audits as needed.
- Developed and implemented Quality Assurance policies, procedures, and standards.
- Identified process improvements which could reduce costs or improve customer satisfaction.
- Supervised onboarding and training of new personnel to maximize capacities of quality assurance team.
Provider Data Management Specialist
Optum Services
Eden Prairie
07.2007 - 03.2011
- Developed and maintained data management policies, procedures, and systems.
- Implemented best practices for data quality assurance processes across multiple systems.
- Identified opportunities to improve data integrity through process optimization.
- Maintained data integrity and performed routine data audits.
- Adhered to company, contract and regulatory requirements when performing data management activities.
- Detected and resolved data quality issues and discrepancies for integrity and quality control.
Education
High School Diploma -
St. Michael Albertville High School
Saint Michael, MN05-1987
Skills
- Credentialing management
- Regulatory compliance
- Data integrity
- Quality assurance
- Provider enrollment
- Process improvement
- Team leadership
- Auditing procedures
- Operational efficiency
Accomplishments
- Led offshore training initiatives: Traveled to India and Puerto Rico to train new teams on Provider Data Management processes and procedures, enhancing team efficiency and performance.
Timeline
Delegated Credentialing Specialist
Optum Services
05.2019 - 01.2025
Provider Data Management Supervisor
Optum Services
03.2016 - 06.2019
Credentialing Quality Assurance Supervisor
Optum Services
03.2011 - 03.2016
Provider Data Management Specialist
Optum Services
07.2007 - 03.2011
High School Diploma -
St. Michael Albertville High School
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