Customer Service Microsoft Office

PROFESSIONAL SUMMARY

Experienced Healthcare Professional with a positive reputation for achieving high levels of patient satisfaction, strong leadership and management skills. She is proficient in quality assurance, program and training development. She has a strong desire to focus on insurance and billing in the Healthcare industry.

AREA OF EXPERTISE

CMS/group benefits and enrollment

NCQA guidelines for credentialing

Claims Processing

NPPS

NPDB

Contract HIPPA, PHI, JACHO, and CLIA guidelines and regulations for insurance company/providers

Primary Source Verification

Call Monitoring (QA)

Type 60/wpm

Collections

TECHNICAL SKILLS

Software: Microsoft Office, Claims processing systems (Maces/IDX), PECOS, CACTUS, Genisis, InTellicred, Vistar, ECHO

PROFESSIONAL EXPERIENCE

CREDENTIALING SPECIALIST

Southeast Anesthesiology Consultants, Charlotte, NC Oct 2016 - Present

Maintain accurate provider records

Update DEA and state license renewals

Using the ECHO system I obtained individual providers initial privileges for facilities (Hospitals, Surgery Centers and Pain Clinics)

Manage reappointments to facilities

Obtained new SC/NC/VA state license, DEA’s, local state privilege license.

Maintained FCVS and CAQH

Assist primary clients consisting of 200 GI’s, 158 anesthesiologists and 78 CRNA’s

Ensure accurate enrollment of providers in Medicare and Medicaid

Track recertification’s, revalidations, and credentialing

Maintain primary Source Verification (NPDB, ABMS, OIG, State Medical Boards, License)

Provide support for office managers, related to credentialing

CREDENTIALING/ PROJECT MANAGER

Frontier Healthcare Billing, Charlotte, NC Oct 2012 – Oct 2016

Provided accurate credentialing of providers for 13 Ambulatory Surgical Centers with managed care, Medicaid and Medicare payers

Maintained provider’s records via CAQH (DEA, State Licenses, and CV)

Assisted primary clients consist of 200 GI’s, 158 anesthesiologists and 78 CRNA’s

Provider enrollment of providers in Medicare and Medicaid and private payers

Tracked timely recertification’s, revalidations, and credentialing

Maintained primary Source Verification (NPDB, ABMS, OIG, State Medical Boards, License)

Provided support for office managers, related to credentialing

Maintained consistent follow up on credentialing process with payers

Created special collections projects based on claims denials for lack of provider enrollment

POLICY HOLDER SERVICES,

Colonial Life and Casualty, Columbia, SC Feb 2011 – June 2012

Acted as primary source of contact for insureds, agents and internal customers resolving issues as related to STD, LTD, Life, Disability, and a myriad of supplemental policies

Human Resource Generalist verifying benefits employees were entitled to receive and assisting employees with filing and processing claims.

Maintained an AHT (Average Handle Time) of 4mins, Adherence of 96%, Customer Satisfaction rate of 98% while handling 60-120 calls per day

Provided a sense of comfort and empathy for a great many of our insureds and families was required due to death or illness

CREDENTIALING COORDINATOR, LEAD

Carolina Crescent/ Absolute Total Care, Columbia, SC Sept 2009 – Oct 2011

Responsible for credentialing and re-credentialing (every 4yrs), for all delegated and non-delegated providers, ensuring that CV’s, Malpractice Insurance, DEA, Licenses, and work history were up to date

Routinely used CAQH, NPDB, State Licenses websites, Student Clearinghouse, ECFMG and various other sites to complete primary source verification.

Updating/maintained company database (Vistar) with provider demographics

Met all NCQA guidelines during the credentialing process and all files were processed within 180 days of attestation

Tracked and logged all new and re-credentialing 90-180 files/ month to be sent to committee meetings

Produced Agenda, Minutes, and Rosters for monthly meetings

Strategically executed and delegated weekly responsibilities to process aging files

TRAINING SUPERVISOR April 2007 – Dec 2008

Delta Dental, Alpharetta, GA

Managed new employees in classes of 20 over an 8-week period to transition into production

Train new and tenured employees the system, basic customer service soft skills and policies and procedures, HIPPA and PHI

Develop manuals and training materials using Microsoft office suites

Conflict resolution (internal and external)

Administering performance reviews and Quality assurance (QA) audits

Monitoring service levels/standards for call center staff of over 80 representatives

Direct Supervision/management of 25 call center representatives at a given time

Web Correspondence and managed DOI inquiries

New claims processing and reprocessing of EDI claims errors at a rate of 30/hour

Intermediate medical/dental coding and terminology and knowledge of UB-4, 1500

Exceeded call center Matrix stats with AHT of 3mins, Adherence of 96% daily

Accepted 80-130 calls per day

CALL CENTER SUPERVISOR Feb 2006 – April 2007

Managed call center representatives and provided training and support

SENIOR REPRESENTATIVE Aug 2004 – Feb 2006

Provided customer service assistance

EDUCATION

Ashford University

Bachelor of Science - Healthcare Management Expected Graduation 2019

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