Independent Remote Credentialing Coordinator

Professional Summary: Experienced, detailed oriented Credentialing Coordinator, who maintains an Independent remote-contracting Credentialing and Billing business. I Come with over 20 years in the Medical Billing (Account Receivable, Payment Posting, Charge Entry, Collections, Customer Service) Arena. My overall purpose is to uphold Critical Relationships and take full responsibility for the credentialing of all providers within your practice.

Skills: Accomplished leader, Strategic planning capability, Analytical thinker, Independent judgment and decision making, Problem Solving, Collaboration, Time Management

System Used: CAQH, PECOS, NCTracks, PalmettoGBA, Novitas, Centricity, MedFlow, NextGen, Ducuware, All Scripts-EMR, ECHO OneApp, Quick Credit

EMPLOYMENT

CREDENTILAING EXPERIENCE:

Aglierta, LLC-Florida & Puerto Rico: 11/2017 to 1/15/2018

Credentials Verification Organization Analyst -Independent Contractor (Remote-part time),

Responsible for processing of applications and reappointment paperwork, checking for full completeness and accuracy. Responsible for constantly collecting and processing significant verification and accreditation information. Maintain and update accurate databases for both practitioners and facilities. These databases include pertinent education, training, experience, and licensure content. Prepare records for regular auditing, as well as maintain close communication with all appropriate practitioners to ensure that records are up-to-date and consistent.

Metrolina Nephrology Associates, PA – Charlotte, NC: 10/2017 to Current

Credentialing Coordinator

Responsible for the initial and overall credentialing and maintenance of all MNA 59 providers

(34 Nephrologists/Vascular Surgeons & 25 Advanced Practitioners: NP’s & PA’s)

within practice, and relevant administrative support to providers.

Responsible for credentialing and maintenance of all MNA (10) facilities.

Responsible for the credentialing and maintenance relationship with Providers, Hospitals, Dialysis Companies, CAQH, Contracted Insurance Companies, Medicare and Medicaid.

Horizon Eye Care – Charlotte, NC: 05/2016 to Current

Credentialing Coordinator/ Managed Care Coordinator

Responsible for the initial gathering of required documents, licenses and completing of applications for

our Ophthalmologist, Optometrists and clinics credentialing/privileging/ reappointment process.

Provide administrative support to the organized Medical Staff and Practice Administrator.

Maintain all medical license, DEA, and malpractice insurance for MD\'s and OD\'s as well as credentialing for all insurance payers. Responsible for maintaining database for 24 physicians and 6 clinics.

Advanced Billing, LLC – Franklin, Tennessee: 02/2016 to 07/2016

Credentialing Specialist-Remote Independent Contractor

Maintain regular cooperation and compliance with all regulatory, accrediting, and membership-based organizations. Create and carry out various credentialing processes in relation to Physical Therapist and Clinical Facilities. Ensure all personnel and services adhere to facility and staff policies, department guidelines, regulations, and government laws. Process applications and reappointment paperwork, checking for full completeness and accuracy. Consistency in collecting and processing significant amounts of verification and accreditation information. Maintain and update accurate databases for both practitioners and facilities. These databases include pertinent education, training, experience, and licensure content. Prepare and store all pertinent documents and information in spreadsheet on One Drive and ebridge; for regular auditing, as well as maintain close communication with all appropriate practitioners to ensure that records are up-to-date and consistent.

MEDICAL BILLING/ACCOUNTS RECEIVABLE EXPERIENCE:

Overall Job Summary: The Billing/Accounts Receivable Specialist is responsible for a variety of duties, as assigned by Manager/Supervisor/Team Lead, which includes problem solving for various payers, including insurance, HMO, Medicaid, Medicare and private pay, routine billing payment posting and special projects in billing and collection. In addition, the Specialist may be responsible for billing and posting for Special Contracts and for obtaining and/or entry of prior authorizations. The billing Specialist is responsible for clear, detailed communication with the clinical and billing staffs and with payers and clients regarding various insurance-related and payment-related issues. Responsibilities included researching and resolving client insurance claims which are denied or uncollected and, also, working with the clinical staff members to resolve billing problems. Always reflecting professional communication with patients with sensitivity, thoughtfulness and a listening ear to properly come to resolve. Other special projects were assigned as needed.

Charlotte Eye Ear Nose Throat-Charlotte, NC 07/2014 to 5/2016

Insurance Reimbursement Specialist

McKesson-Charlotte, NC 08/2009-2/2014

A/R Specialist

Southeast Anesthesiology-Charlotte, NC 07/2008-07/2009

Insurance Reimbursement Specialist

EDUCATION

Central Piedmont Community College-Charlotte, NC

Associate Degree of Applied Science: 2015

ADDITIONAL AREAS OF EXPERTISE

Managed Care Coordinator~ Seasoned Medical Biller ~ Department Trainer ~ Accounts Receivable Specialist ~Team Leader~ Experienced Insurance Payer Rep~ Customer Service-Excel spreadsheets

ACCOMPLISHMENTS

Created a step by step manual guide on every aspect of Credentialing and Managed Care

Enrolled and credentialed 4 New Ophthalmologist (3 from fellowship, 1 from Military) and 1 Physician Assistant in the past year. This includes Hospital Privilege Credentialing with Novant Health Presbyterian Medical Center, Carolinas Medical Center, Iredell Surgical Center, Union West Surgery Center, TLC Laser Eye Center

Revamped HEC Payer Matrix guide (excel spreadsheet) into a user-friendly guide to be used by HEC Practice Managers, Front and Back End Reps, Call Center and Business Office Representative.

Extensive experience handling a variety of different clientele through various levels of communication, from Provider Relations to independent contractors

References Available Upon Request

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