W. Jerry Blackshire

**** * ******

Plano, Texas 75074

EMPLOYMENT

**** - ******* **** ***** *** Blue Shield of Texas Richardson,

Texas

Sr Credentialing Representative - Provider

Administration

Research and resolve credentialing cases. Collect

work history data, verify Licenses, DEA/DPS

registration. Query NPDB,OIG and MEDOPT data base.

Set up and maintain provider information on

multiple provider databases to reflect

credentialing activity. Respond to provider

2004 - 2008 regarding credentialing decisions and related

issues. Apply quality assurance processes to ensure

data integrity along with maintaining quality and

volume ratios based on department standards.

Internal and External phone communication to obtain

or give information.

Precertification Analyst-Utilization Management

Division

Worked with Utilization Review area. Taking inbound

calls setting up precerts and referral.

Knowledgeable of all contract interpretation.

Knowledge of ICD9 and CPT4 coding, as well as claim

processing. Collect structural clinical and

EDUCATION non-clinical data. Verify eligibility for MD

office, hospital and subscriber. Approve hospital

admit and discharge cases out of system. Run admit

and discharge reports. Data entry

Customer Service-Membership Division

Extensive written and oral communication with

customers, agents, and internal sources. Verified

and updated database, on policies and pending

SKILLS applications. Set up supplies ordering system for

the department. Set-up 10-day refunds.

International School of Business

McKinney, TX

Collin County Community College

Plano, TX

International School of Business

Dallas, TX

Dallas County Community College

Dallas, TX

Experience utilizing various Windows based software

to include: Excel, Microsoft 98, and Outlook.

Typing 55wpm, ten keys by touch, time management

and interpersonal skills also, trained in

peoplesoft, medisoft, medical management and

eclipse.

References upon Request

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