About the founder

My name is Shirley, and I didn’t grow up dreaming about credentialing and billing—but that’s exactly where I found my lane. I didn’t come into healthcare through the front door with stethoscopes and white coats. I came in through the back door, through error logs, rejection reports, and claims files that nobody else wanted to touch. I built my career in the parts of healthcare most people never see and definitely don’t want to deal with. And that’s exactly why I’m here: because the stuff most people avoid is the stuff that controls whether you actually get paid.

My story really started with Indiana Medicaid. I was knee-deep in EDI support, living inside 837 files, loop and segment errors, and piles of rejected claims. It wasn’t glamorous. There were no “thank you” balloons when a claim was finally paid. It was mainly frustration—on the providers’ side, on the billing staff’s side, and sometimes on my side when I saw the same avoidable mistakes over and over again. Every day, I chased the same question: Why didn’t this get paid? That question became my mission. I’d sit there with a denial, pull the batch file apart line by line, and trace the problem back to its source—bad enrollment, wrong taxonomy, mismatched NPI, missing data, or a broken link between a provider and a payer. That’s where I learned how one tiny error in one field can quietly shut off an entire provider’s cash flow. The waiting room can be full, the schedule can be packed, but if the data pipeline is wrong, the money stops.

Working with EDI taught me something important: claims don’t get denied randomly. There’s always a reason, even if the payer’s message makes it sound vague or generic. I saw firsthand how many practices were operating in the dark. They knew how to provide care. They knew how to see patients. But the moment their work turned into a claim file, it entered a world they didn’t understand. I listened to providers who were confused, office managers who were burnt out, and billing staff who felt like they were constantly putting out fires. That’s where I started to realize I wasn’t just “fixing files”; I was translating between two worlds—the clinical side and the payer side.

At some point, I realized I wasn’t just “good at paperwork.” I was building systems that protected revenue. I was the person connecting the dots between credentialing, enrollment, billing, data integrity, and payer rules. I understood how a misstep in the credentialing phase could cause months of denials. I saw how sloppy enrollment work could block ERA and EFT setup, delay cash, or cause checks to go who-knows-where. I also saw how many practices had no idea this was happening until they were already in trouble.

That realization is what pushed me to step out on my own. In 2023, I founded Healthcare Credentialing, Consulting, and Medical Billing in Indianapolis. On paper, it’s a business that provides credentialing, consulting, and billing services. In reality, it’s the result of years of seeing what goes wrong when nobody is really owning this part of the process. I didn’t create the company to be “just another billing service.” I built it to be a partner that guards revenue from the start—before the first claim ever goes out the door.

Today, I help practices get credentialed with both commercial and government payers, and I do it with a very clear mindset: compliance first, clean claims, and no shortcuts that will backfire later. That means making sure enrollment data is accurate, contracts are understood, and providers know what plans they’re actually participating in. It means mapping NPIs, TINs, locations, and plans correctly so that EDI, ERA, and EFT all flow as they’re supposed to. It means going beyond “submit and hope” and moving into intentional, documented, trackable processes.

On the billing side, my focus is simple: clean, compliant claims the first time. I’ve seen enough denials to know that a large percentage are preventable with better front-end work—eligibility verification, benefit checks, demographic accuracy, and the correct pairing of CPT/HCPCS codes with ICD-10 diagnosis codes. When claims are denied, I don’t just resend them and cross my fingers. I want to know why. I want to fix the root cause—whether it’s a credentialing issue, a contract problem, a coding mismatch, missing documentation, or a policy the practice didn’t even know existed. My goal is always the same: get claims paid faster, reduce system noise, and stabilize cash flow.

I also work with medical offices, behavioral health practices, and telehealth providers to build or rebuild their workflows. That includes how they conduct eligibility checks, obtain prior authorizations, document services, manage denials, and communicate internally among the front desk, clinical staff, and billing. Many practices operate in a constant “firefighting” mode. Someone calls when something is broken. Someone rushes to fix it. Then the cycle repeats. I step in to break that pattern and replace it with clear, repeatable processes—so staff can stop living in crisis and start working in control.

Along the way, I also built a virtual assistant agency out of the Philippines. That wasn’t an accident; it was a response to a real problem I saw over and over: practices drowning in administrative work they couldn’t keep up with. I work with virtual assistants who are trained specifically for healthcare back-end work—credentialing, eligibility verification, prior authorizations, EDI/ERA enrollment, claim follow-up, and denial cleanup. These aren’t random administrative helpers; they’re trained to operate in the same world I came up in. That allows practices to offload heavy, repetitive tasks while still keeping tight control over their revenue cycle operations.

People who work with me will tell you I’m direct. I’m not into fluff, I’m not here to make payers sound better than they are, and I’m not going to pretend that a bad process will magically fix itself. I’ve seen what happens when credentialing is done halfway, when billing is rushed, when data is ignored, or when a practice assumes “the system” will be fair. It’s not always fair. But it is predictable—if you understand how it works. I’d rather show you exactly where your process is broken, tell you what it’s costing you, and then help you fix it.