Aaron K

Senior Credentialing, State Licensing & Payer Contracting Consultant - Freelance

Self employed / Freelance • Freelance

Jan 2010 - Present • 16 yrs 10 mos

Manage end-to-end credentialing, payer enrollment, and regulatory licensing for physicians, mid-level practitioners, group practices, independent clinical labs, DME providers, and pharmacies across all 50 US states. Provide specialized consulting for startup clinical laboratories and expanding physician groups, establishing full credentialing frameworks, CLIA compliance, and operational roadmaps from scratch. Direct molecular diagnostic lab compliance, including Palmetto GBA DEX Z-Code registration and preparing documentation (SOPs, clinical utility, CPT mapping) for AMA Proprietary Laboratory Analyses (PLA) code applications. Execute full 50-state licensing protocols for facility operations, including State Medical Boards, CLIA lab certifications, Pharmacy licenses, and Medicare DMEPOS supplier requirements. Perform rigorous contract analysis and commercial fee schedule evaluations, negotiating directly with payer network managers to secure increased reimbursement rates and optimal contract terms. Oversee Medicare PECOS enrollment setups, MAC-specific documentation, 5-year mandatory revalidations, group reassignments (CMS-855R), and direct EFT registrations (CMS-588). Draft customized, high-converting Letters of Interest (LOIs) highlighting unique practice strengths, service regions, and specialized coverage to secure contracted panel spots. Navigate California Workers’ Comp Medical Provider Network (MPN) workflows, submitting application packets and negotiating directly with panel administrators for SCIF, Coventry/Enlyte, and CorVel. Maintain provider profiles on CAQH ProView, Availity, Optum, and PECOS, performing quarterly attestations and demographic updates to eliminate billing holds.