Customer Service Insurance

Candace E. Dudley

**** ****** **** ****

Winston-Salem, NC 27105

336-***-****

abl9r8@r.postjobfree.com

Work Experience: 2011 - Present PEC Management

Credentialing Specialist

. Maintain a reminder system for all licenses due/past

due

. Maintain spreadsheet of all provider numbers

. Maintain and update CAQH website as needed

. Newly Hired Providers

o Confirm active license from the medical boards

o Confirm active DEA certificate

o Secure approval from Liability carrier for

Professional coverage

. Apply for participation with various insurance

companies including Medicare and Medicaid

. Complete evening triage schedules

. Maintain provider files with current documents

required for credentialing and re-credentialing

. Send out weekly time sheets to providers

. Ordering and storing prescription pads

. Renew physician privilege licenses annually

2011 - Present PEC Management

Compliance

. Keep policy manual current

. Research any new regulations

. Organize meetings as needed throughout the year

2010 - 2011 Salem Solutions

Temporary Credentialing Specialist (PEC Management)

. Same duties as describe above.

2010 - 2010 MED3000

Medical Billing Specialist II

. Denial follow up

. Customer Service to patients with questions

. Demographic updates such as address, insurance, and

guarantor information

. Transferring incorrectly posted payments

. Contacting insurance companies with questions

concerning denials

. Correcting CPT and ICD-9 codes when appropriate

. Verify active insurance coverage

2009 - 2010 Debbie's Staffing (EMS Management &

Consultants)

Billing Specialist

. Entering demographic information, insurance,

diagnosis and charge information on patient accounts.

2005 - 2009 Excel Imaging, LLC

(formerly Forsyth Radiological Associates)

Credentialing Coordinator

. Maintaining credentials for all full and part time

physicians and midlevels

. Obtaining hospital privileges at 4 hospitals

. Maintaining those privileges with re-appointment

submissions

. Submitting applications and documentation for

provider enrollment with contracted insurances as

participating providers

. Updating and maintaining physician profiles using

credentialing software as well as a paper file.

2007 - 2009 Excel Imaging, LLC

(formerly Forsyth Radiological Associates)

Contract Invoice Representative

. Adding patients to contract invoices via data entry

outside film reads at a contracted negotiated fee

. Invoicing physician offices monthly for contract

reads

. Posting payments to said contracts and issuing

followup reminders for non-payments

. Customer service to those with questions concerning

their invoices

2007 - 2009 Excel Imaging, LLC

(formerly Forsyth Radiological Associates)

System Maintenance Representative

. Loading and maintaining system maintenance files such

as referring physicians, insurances and fee schedules

1999 - 2006 Forsyth Radiological Associates, PA

EDI Coordinator

. Accumulating a daily claims file

. Correcting any information needed to file clean

claims files

. Submitting claims to a clearinghouse

. Downloading electronic remittances

. Accumulating a weekly file for patient statements and

collection letters

1989 - 2001 Forsyth Radiological Associates

Medicare Insurance Representative

. Posting payments to patient accounts both manually

and electronically

. Denial follow up

. Customer service to patients with questions

. Medicare third party liability (motor vehicle

accidents)

. Submit claims to third party liability carriers and

performed follow up

Education: 1984 - 1986 North Forsyth High School

Diploma

References: Available upon request

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