Customer Service Medical

Adam Bushman Resume pg. *

ADAM T . BUSHMAN

**** ********* ***, ***** **********, FL 33068

954-***-**** ****.*.*******@*****.***

www.linkedin.com/in/adam-t-bushman

EXPERIENCE 3/2017 – Present Memorial Physician Group Miramar, FL Provider Relations Representative

• Enroll and Re-enroll Medical Staff Providers, including Physicians and Allied Health Professionals in Managed Care Plans

• Maintain CAQH for our providers in Managed Care Plans

• Comply with The Joint Commission and NCQA Standards

• Review and update credentialing files of all providers within the practices in all divisions of the Memorial Physician Group

• Conduct Primary Source Verification while waiting to be provided with the actual certificates (license, boards, etc.) from the Practice Managers of all Divisions within the South Broward Hospital District

• Maintain relationships among all Division Heads and Practice Managers to facilitate and improve communication and flow of documentation between the Memorial Physician Group practices and Medical Staff Services

• Request and upload to CAQH documentation pertaining to each provider: o License

o DEA Certificate (if applicable)

o Letter of Liability

o Board Certificates

o Diplomas

o CV

o CAQH Release forms

• Create, update, and review multiple Excel Workbooks simultaneously

• Compose requests for information and formal documentation

• Assist in the implementation of Quality Improvement with Management. 11/2014 – 2/2017 Broward Health Fort Lauderdale, FL Credentials Specialist

• Accepted requests for and screened pre-appointment applications

• Provided online applications after approving pre-appointment applications

• Reviewed and analyzed online applications for accuracy and completeness

• Obtained Primary-Source Verifications (PSV) for the following: o Medical/Professional Training and Board Certifications o Licensure, NPI, and DEA Certificates (if applicable) o Malpractice Claims and Compliance with Financial Responsibility Law Adam Bushman Resume pg. 2

(Broward Health, Continued)

• Enrolled applicants in the National Provider Databank

• Performed investigations of background including Sanctions/Exclusions

(SAM/OIG)

• Obtained drug screens

• Compared CV to the application

• Identified/investigated gaps of more than 30 days after completion of training

• Obtained and reviewed three professional references, from affiliations with hospitals and employers, and reviews from program directors of internships, residencies, and fellowships

• Conducted internet research of all candidates

• Reviewed and analyzed all application information

• Followed-up with each applicant regarding status of his/her application

• Prepared summary reports (Abstracts) for each applicant

• Communicated with the Managers of Medical Staff Offices regarding status of application and forecasted completion dates

• Prepared and submitted complete application packets to Medical Staff Offices. 10/2013 – 8/2014 Advanced Patient Advocacy Fort Lauderdale, FL Medicaid Eligibility Advocate and Affordable Care Act Navigator

• Screened patients in the Emergency Department at Holy Cross Hospital for Medicaid eligibility

• Submitted Medicaid applications on behalf of the patients, communicated with the Department of Children and Families’ caseworker regarding outstanding Medicaid applications from initial applications up through determinations

• Advised hospital billing department of patients’ Medicaid coverage

• Screened outpatients of Bethesda Hospital East and of Holy Cross Hospital by telephone and in person for participation in the Affordable Care Act (ACA)

• Enrolled outpatients and other consumers in Qualified Health Plans (QHP) under the Affordable Care Act (ACA)

• Planned outreach events to educate consumers about and enrolling them in QHP

• Continuously educated the population of Broward and Palm Beach Counties about the ACA and provided Health Insurance 101 (definitions of all managed care terminology.

Adam Bushman Resume pg. 3

5/2012 – 10/2013 Medical Staffing Network Boca Raton, FL Credentialing Specialist

• Participated in the development and implementation of credentialing processes and procedures

• Assigned and gathered credentialing documents for traveling nurses across the United States

• Performed Quality Assurance (QA) based on TJC, Federal, State, Company, and Client guidelines

• Met and exceeded QA guidelines with 100% accuracy. 12/2011 – 5/2012 QuantumCare TPA Pembroke Pines, FL Claims Coordinator for University of Miami Behavioral Health (UMBH)

• Team Leader for five Claims Processors for UMBH Medical Billing and taking escalated Customer Service telephone inquiries

• Performed Quality Assurance on medical claims

• Acted as liaison between QuantumCare and Provider Relations at UMBH

• Processed and adjusted claims from CMS-1500s and UB-04s from over 800 behavioral health providers with speed and accuracy. 3/2011 – 11/2011 The CSI Companies for Aetna Plantation, FL Intake Representative (Temporary)

• This was originally a 90-day, part-time assignment. My position was extended to 8 months, full-time

• Customer Service in call-center environment

• Initiated Short-Term Disability Claims and FMLA absences from claimants and employers.

5/2010 – 10/2013 Pearson Professional Center Deerfield Beach, FL Test Administrator

• Front Desk Administration and Customer Service.

• Validated testing candidates’ identification credentials via government-issued photo identification along with Biometrics

• Proctored educational and professional exams.

EDUCATION California State University, Long Beach Long Beach, CA Bachelor of Arts: Sociology, with Emphases in Medical Sociology and Family/Intimate Relations

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