Medical Assistant Manager
Resume:
Kenyata Golden
**** ***** ******, *********, ** *3023 305-***-**** **************@*****.***
Objective
My objective is to secure a position in a stable and growing organization as a credentialing specialist for a healthcare organization or healthcare provider. To ensure that physicians and healthcare facilities are in compliance with the current and relevant regulations. Furthermore, I wish to contribute my knowledge and skills in the healthcare field as an experienced medical assistant and credentialing specialist to enforce regulatory compliance and quality assurance and to become a valued asset to a company that I can grow within, I am also open to relocation.
Experience
CREDENTIALING MANAGER PAYER PRO 02/2018-PRESENT
Company start up creating policy and procedures to get the company NCQA certified as an CVO.
Credentialing Transportation providers Epic NEMT.
Monitor and update internal database with physicians expired license.
Prepare all packages for assigned providers to be submitted to the appropriate health for provider enrollment participation with said health plan.
Coordinates the management of the electronic credentials applications, to ensure distribution and receipt.
Function as primary CVO credentialing manager for all internal and external inquires.
CREDENTIALING COORDINATOR- INTERIM (MANAGER) CHEN MEDICAL 01/2016- 01/2018
Credentialing new physicians with hospitals, insurance companies and membership applications including for FQHC’s.
•Enter initial applications into company credentialing program.
•Adhere to Medicare guidelines and process new MDs and NPs into the PECOS system as well as the EHR program of Medicare, also maintain the process through Florida Medicaid threw Clearinghouse process for new applicants.
•Re-credentialing and Renewal- ( 6 states)
•Forward ALL newly renewed certificates to all hospitals and enter into the company credentialing program as they become available during the year including Medical Licenses, DEA’s, Malpractice COI’s
•Manage electronically related correspondence and documents.
•Meet with management periodically and provide updates on current projects.
•Monitor insurance company and society websites for accuracy about our group/physicians and have corrections made as errors are discovered.
•Keep current status reports for management.
Train all new hires on all credentialing software along with the multiple states requirements
•Manage Hospital Appointments, Insurance Providers, Insurance Websites, Medical Licenses, DEA’s and Business Licenses Monitor and manage all Professional License and NPI for expiration dates and take appropriate action.
CREDENTIALING SPECIALIST ALL MEDICAL PERSONNEL – IDEAL PERSONNEL 06/2013 – 12/2015
Complete and review, with accuracy and thoroughness, all newly hired healthcare providers credentialing and re-credentialing applications within the appropriate timeframe.
Respond promptly to all questions and concerns received via email or telephone from the credentialing manager, provider, or facility.
Monitor and update internal database with physicians expired license.
Prepare all packages for assigned providers to be submitted to the appropriate health for provider enrollment participation with said health plan.
Follow up on every application every 14 days until the file has been completed.
Maintain an audit accuracy of 95%.
SENIOR CREDENTIALING SPECIALIST HEALTH CHOICE NETWORK] 12/2007-06/2013
Complete all initial credentialing / re-credentialing applications according to policy and procedures
Coordinate with manager for prioritizing activities to meet new business needs.
Provide monthly monitoring of multi-state Medicare/Medicaid Sanctions to meet all regulatory, accreditation and contracted client's requirements
Provide continuous monitoring, downloading, verifying and filling of expired credentialing documents: license, DEA and Insurance documents.
Contribute to Credentialing Department meeting agenda for continuous staff in servicing
Assist in meeting preparation to maintain strict level of confidentially for all matters pertaining to provider credentials and proprietary information
Ensure compliance with department and company adopted policies/ procedures/ processes, programs and plans other duties, as assigned.
Maintain site visit for the Miami Dade locations.
Handle additional projects as needed, such as scanning, filing and updating information in MSO
Communicate with Managed Care representative when necessary.
Reads and abides by the company’s code of conduct, ethics statements, employee handbook(s), policies and procedures and other corporate mandates, including participation in mandatory training programs.
Reports any real or suspected violation of the corporate compliance program, company policies and procedures, harassment or other prohibited activities in accordance with the reporting policies of the company.
Obtains clarification of policy whenever necessary and may use the resources available through the Compliance, Human Resources or Legal Department to do so.
Perform monthly audits of 4 employees to ensure all rules and regulations and federal/state guidelines are being followed by every member of the credentialing team.
MEDICAL ASSISTANT DR. BLEMURE FAMILY MEDICINE 01/2003 – 12/2007
Escort patients to exam rooms, interview patients, measure vital signs, including weight, blood pressure, pulse, temperature, and document all results into the patients chart.
Ensure all related lab reports and related information is readily available in the patients chart.
Keep exam rooms stocked with adequate medical supplies, instruments and prepared sterilization as required.
Assist physicians in exam rooms.
Triage patients and process messages from patients and front office staff to the doctors.
Give clear and precise instructions to patients as directed by the physician.
Call in pharmacy prescription refills and maintain logs of required checks for emergency medication, supplies, refrigerator temperature and oxygen.
Adhere to HIPAA policies and procedures.
Ensure all patients medical records were filed and secured according to HIPAA guidelines
Maintained patient privacy at all times.
Education
MEDICAL ASSISTANT 10/2002 TECHINCAL CAREER INSTITUE
Medical Assistant Diploma
Graduated with honors
3.5 GPA
HIGH SCHOOL DIPLOMA 06/1998 WILLIAM H. TURNER TECHNICAL INSTITUTE
3.7 GPA
Graduated with honors
Top 20% of the class
Sitting for CPCS Certification-03/2019
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