Francis Charles Shanahan PSV (Primary Source Verification) Credentialing and

Credentialing Consultant

evercred

Aug 2025 - Current (1 year)

• Assist with the development of an AI-technology-based credentialing software platform to enhance and expedite the credentialing and onboarding process for contracted physicians • Assist with the development of the corporate credentialing program to secure future NCQA certification as a CVO (Credentialing & Verification Organization)

Credentialing Specialist

SoNE HEALTH

Oct 2024 - May 2025 (8 months)

Compiles/Coordinates current enrollment material. Coordinates the mailing of current enrollment material to potential practitioner members, ensuring that the current versions of forms are being used. Works in conjunction with the Medical Staff Office and collaborates with other departments and practitioner offices to obtain materials needed for credentialing and enrollment as part of the credentialing process. Coordinates receipt of credentialing/enrollment materials Follows up on any missing items in a timely manner.

Provider Enrollment Representative I

Noridian Healthcare Solutions LLC

Jun 2024 - Jul 2024 (2 months)

Researches and controls incoming applications and correspondence to ensure work is properly categorized Enters data into internal document management and workflow systems Provides quality check on the provider enrollment data and enters application information into claims processing systems Manages inbound/outbound online FAX queues to and from providers Quality assurance checks of claims processing system enrollment data Creates and mails notification letters Completes application returns and/or application acknowledgement process Support other enrollment functions such as status calls, basic data entry, special mailings, etc. Reviews, researches, and processes provider enrollment applications abiding by contract regulations, internal poli

Credentialing Coordinator - Database Management

University Health KC

Sep 2023 - Nov 2023 (3 months)

Assist with data migration from Visual Cactus to Web Cactus Assist with data management, auditing, transfer, and validation for privileged facility healthcare practitioners Assist with audit and uploading of key supporting documents for privileged facility healthcare practitioners Other ancillary projects related to migration/transfer of data, as requested

Business Analyst - Provider Data Management

Coordinated Care

Apr 2023 - Jun 2023 (3 months)

Triage, respond and review provider emails, research, enroll, term practitioners. Update/research/audit all types of provider data. Scrub excel files.

Credentialing Specialist II

Avesis

Jun 2022 - Jan 2023 (8 months)

Receives and processes incoming applications and supporting credentials from providers Performs timely follow-up with providers on all pending applications Performs the primary source verification according to departmental policies and NCQA standards when not completed by CVO Builds and accurately maintains provider information in various systems Performs Quality Assurance of all provider credentialing information in preparation for committee(s) Responds to inquiries regarding the status of provider’s application Utilizes organizational templates to communicate with providers about the status of their application with the organization Provides support to Credentialing Specialist I on functional responsibilities

Credentialing Coordinator

MAXIMUS

Dec 2021 - Apr 2022 (5 months)

Collect credentials of incoming providers as per work instructions. Perform primary source verifications of all practitioner credentials, including but not limited to licensure, DEA, and other credential sources. Perform data enter into various systems used to credential and recredential staff. Maintain and track copies of current state licenses, DEA certificates, infection control, and trainings. Maintain necessary logs, lists, records, and current documentation required for provider credentialing. Provide regular reports on pending staff and those who have cleared credentialing.

Operations Associate

Nomad Health

Jul 2021 - Sep 2021 (3 months)

Support Joint Commission and Nomad standards to achieve 100% compliance Process compliance files in accordance with corporate policies and procedures, and any relevant client requirements (primary source verifications, background/drug screenings, etc.) Facilitate and track onboarding paperwork Review talent paperwork for accuracy and completeness Consistently communicate with all customers regarding the status of clinician compliance file Escalate issues to leadership when appropriate Monitor and notify clinician of upcoming expiration dates of required compliance documents Maintain and update compliance records in Nomad and client/VMS databases as required

Credentialing Specialist

Symplr

Nov 2020 - May 2021 (7 months)

Compile confidentially, accurate primary sourced data to facilitate customers in the decision making process for practitioners/providers with health care plans, hospitals, surgery centers, and/or other health care institutions. Extensive, direct interaction with health plans, government agencies, practitioners/providers, and customers. Process, review, and maintain all practitioner/provider credentialing and re-credentialing files and offer solutions regarding the workflow of credentialing files. Enter and update practitioner/provider data in the credentialing database while adhering to input standards. Process complete initial and re-credentialing applications within the expected timeframes. Perform primary source verification in accordan

Credentialing Consultant

HPEC

Aug 2020 - Current (6 years)

•Assist with the development of an AI-technology-based credentialing software platform to enhance and expedite the credentialing and onboarding process for contracted physicians • Assist with the development of the corporate credentialing program to secure future NCQA certification as a CVO (Credentialing & Verification Organization)

Health Plan Credentialing Specialist

TapestryHealth

Apr 2020 - Jun 2020 (3 months)

Manage the credentialing process with the billing company in order to ensure that clinicians are enrolled with the correct payors. Maintain records related to insurance contracts and staff credentials. Pursue and obtain any that are not in compliance. Works with the contracted billing company to create a complete database of all clinician health plan credentials. Stay in contact with staff and insurance companies to ensure that they have all the necessary documents and inform them of any changes in contracts and policies. Assist the Billing and Compliance team in training, support, and evaluation of documentation. Responsible for interacting with the billing company to ensure all claims are accurate and submitted for payment in a timely man

Credentialing Coordinator

DirectShifts

Dec 2019

Oversee credentialing of contracted/employed physicians and advanced level practitioners in order to facilitate corporate onboarding and secure clinical privileges at contracted healthcare facilities for the provision of locum tenens services

Credentialing Advisor

Axuall

Sep 2019 - Nov 2019 (3 months)

Assist with development and product management for blockchain technology-based identity verification and credentialing software system for major healthcare clients.

Credentialing Manager

Third Eye Health

Apr 2019 - Aug 2019 (5 months)

Oversee credentialing of contracted/employed physicians and advanced level practitioners in order to facilitate corporate onboarding and secure clinical privileges at contracted SNF's and acute care facilities for the provision of telemedical services

Privileging & Enrollment Specialist

Curve Health

Mar 2018 - Sep 2018 (7 months)

Development and oversight of practitioner credentialing, state licensing, and clinical privileging for telehealth/telemedicine services provided at contracted skilled nursing facilities as well as provider enrollment with private and government payer organizations

Credentialing Coordinator - Contractor

ConnectiCare

Aug 2017 - Mar 2018 (8 months)

Assist with re-credentialing and file management updates for all participating network providers (PCP/Specialist Physicians, Mid-Level Practioners, and Allied Health Providers) within the organization's CT, MA, NY & RI market areas

Credentialing Coordinator, Managed Care

Western Connecticut Health Network WCHN

Feb 2017 - Apr 2017 (3 months)

Oversee credentialing and enrollment of WCHN employed healthcare practitioners with private and government payors. Responsible for providing credentialing reporting and ongoing support to WCHN administration and providers

CVO Business Development Consultant

LARION

Jun 2016 - Jul 2016 (2 months)

Assisting with business development consultative services for organizational establishment within U.S. managed care, healthcare facility, and multi-specialty group C.V.O. (Credentialing & Verification Organization) markets. LarionComputing is a 150+ person, CMMI Level 3 + ISO9001:2008 certified software development firm, focusing on the Healthcare and Financial Services arenas.

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Compliance Analyst/Credentialing Specialist

Charter Oak Health Center

Jan 2016 - Mar 2016 (3 months)

Responsible for managing the credentialing and privileging of all licensed independent practitioners (LIP’s) as well as other staff identified by Federal Tort Claims Act (FTCA) regulations and guidelines. Responsible for implementing and monitoring enrollment with State Federal and commercial vendors, and communicating effectively and timely with internal and external entities.

Healthcare Consultant

Hardenbergh Group

Jun 2015 - May 2016 (1 year)

Representing The Hardenbergh Group, LLC in providing interim healthcare management & credentialing consultative services to nationally contracted client organizations

Consultant/Interim Credentialing Specialist Yale-New Haven Hospital

Yale New Haven Hospital

Jun 2015 - Oct 2015 (5 months)

Process provider applications in timely manner within verification time limit Review applications for completeness of the application and supporting credentials, including current status of all time-sensitive information. Maintain applications submitted into the credentialing database. Request and obtain all missing information and/or updated information related to the application or source documents. Perform primary source verification of all supporting provider credentials through telephone, fax, and online systems. Obtain primary source verification of credentials including, but not limited to, licensure, education and training, and specialty board certification. Query online databases for malpractice and sanction reports. Obta

Interim Credentialing Manager

Healogics LLC

Jan 2015 - Apr 2015 (4 months)

Responsible for oversight of clinical credentialing operations for physicians and mid-level practitioners contracted to provide onsite healthcare services at established hospital-based and free standing corporately owned Wound Care Centers throughout the continental United States.

Interim Director of Credentialing

PCP Financial Services

Oct 2014 - Nov 2014 (2 months)

Responsible for assistance with development of the credentialing and privileging processes for all medical practitioners who provide patient care for Physicans Group Services, PA/Coastal Spine & Pain Centers. Ensured providers were credentialed, appointed, and privileged with health plans, hospitals, and patient care facilities. Maintained up-to-date data for each provider in credentialing databases and online systems; ensured timely renewal of licenses and certifications

Credentialing SME Consultant

Doctors Plus

Jun 2014 - Sep 2014 (4 months)

Provided Credentialing and Provider Enrollment expertise and experience to the future growth of Doctors Plus' national provider network as well as assistance with the marketing of credentialing products and services.

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Independent Credentialing SME and Organizational Consultant

Francis C Shanahan

Jan 2014 - Current (12 years 7 months)

Provide credentialing, quality management, practitioner relations consultative services, and credentialing/PDM software development design and implementation assistance to private and government managed care organizations, healthcare facilities/systems, physician groups/networks, and healthcare technology corporations

Healthcare Management Consultant, Global Credentialing Operations

UST

Jan 2014 - Apr 2014 (4 months)

Independent strategic consultant working with international healthcare organization for the development of provider and facility Credentialing programs, policy and SOP improvements, and the training and mentoring of US and offshore program personnel

Socioeconomics Project Coordinator

American Association of Clinical Endocrinology AACE

Jun 2012 - Sep 2013 (1 year 4 months)

Responsible for the coordination of activities for the Socioeconomics & Member Advocacy department relating to healthcare financing and third party reimbursement, legislation, regulation (in consultation with the Department of Legislation and Government Affairs) and other factors which affect the practice of clinical endocrinology. Provide assistance to the Association membership on issues specific to, but not limited to, endocrine coding, claims denial & reimbursement, and third party private and governmental payer relations.

Credentialing Manager

MDI

May 2007 - May 2012 (5 years 1 month)

Managed the initial appointment and cyclical reappointment of all licensed independent practitioners and allied health providers applying for initial credentialing and recredentialing for provision of healthcare services at contracted Federal Bureau of Prison and Corrections Corporation of America institutions

Contractor/Provider Data Services Integration

Florida blue

Dec 2006 - Apr 2007 (5 months)

Provided oversight of network contracting process initiative for Florida ancillary providers enrolled in the BCBS Medicare Advantage PPO program

Credentialing Manager

ValueOptions Inc

Aug 2004 - May 2006 (1 year 10 months)

Managed the initial appointment and cyclical reappointment of all behavioral health providers applying for initial credentialing and recredentialing within the TRICARE South Region network.

Credentials Specialist

St Vincent Medical Center

Dec 2002 - Aug 2004 (1 year 9 months)

Managed the multi-specialty initial appointment and cyclical reappointment of all physicians and allied health practitioners duly privileged with the facility.

Quality Consultant

Aetna a CVS Health Company

Feb 2000 - Feb 2002 (2 years 1 month)

Oversaw the quality assurance of NE Florida initial and recredentialing provider applicants and managed the Credentialing & Performance Committee review and approval process.

CVO Mentor & Trainer

Aetna

Jun 1998 - Feb 2000 (1 year 9 months)

Organized, prepared, and presented credentialing & verification curriculum to new hires and post-acquisition employees and demonstrated use of credentialing & verification technology.

Senior Quality Analyst

Aetna

May 1997 - Feb 2000 (2 years 10 months)

Processed primary source verification of allied health & physician provider credentials to ensure that verification activities were performed in compliance with NCQA credentialing accreditation standards setforth for CVO's.

Francis Charles Shanahan

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