Contracting Assistant/Credentialing
Resume:
Nikia M. Reid
Apt ****
Houston, TX 77065
**********@*****.***
Objective
I am looking for a position within the medical environment that allows me to contribute for
knowledge.
Education
Baker College - Allen Park, MI
Associate of Applied Science, Medical Insurance Specialist
Expected June 2014
Course taken: Medical Terminology, Medical Coding, BLS, and First Aid
(3.2 G.P.A.)
Dean’s list (Winter 2014)
Professional Affiliations
American Academy of Professional Coders (AAPC)
Experience
Health Alliance Plan (Henry Ford Health System)
Detroit, MI
April 2012 – June 2014
Provider Contracting Assistant II
Assist the Physician Hospital Organizations with contracting physicians.
•
Educate providers with the contracting process and obtain the proper documents needed
to start the credentialing process.
Contact non-providers and extend the offer to become a participating provider.
Prepare Contract packages, Agreements and Amendments for mailing to potential
Providers
Coordinate Provider Agreements, Amendments and Letters of Agreement with non-
contracted providers.
Assist in the coordination, tracking, and ensuring the credentialing process is complete
for Providers.
Maintain network availability.
Confirming physician credentialing in Cactus database
Coordinating work with other staff.
Henry Ford Health System
Detroit, MI
September 2011 - April 2012
Clinic Service Representative (Gastroenterology Department)
Scheduled, cancelled patient appointments and Contacted patients with appointment
•
reminder calls
Answer incoming calls and serve as liaison between patients, section administrative staff
•
and healthcare professionals.
Maintained documentation of calls received and problems encountered that need
•
administrative follow-up.
Alerted the physician staff via web, when a patient arrives for their schedule appointment.
•
Verify and update all demographic, insurance and meaningful use information.
•
•
Henry Ford Health Products
Southfield, MI
June 2010- September 2011
Customer Support Specialist II
Requested release of medical records for review.
•
Extracted medical documentation from medical records to provide DME orders.
•
Documents work performed/action taken on AR Aging Reports.
Processes rejections and denials to determine if the claim needs to be re-filed or
submitted for an appeal with the payer
Investigated and reviewed the insurance coverage for durable medical equipment
regulations.
Arcadian Health, (Humana)
Charlotte, NC
December 2009 - June 2010
Membership Representative
Requested member identification cards, providers directories, explanation of benefits and
•
other materials to be mailed to the members.
Answered any prescription drug coverage questions. Researched prescription drug
•
coverage questions, and verified Medicaid/ Medicare coverage for providers.
Educated the providers and the members with the referral/authorization process
Checked benefits and eligibility for providers.
•
Verified which CPT codes/procedure needs authorizations.
Skills
Ability to type 75 WPM
Microsoft Office/ Word/Excel/PowerPoint/ Adobe Professional
Wide experience in medical billing, provider registration and administration
Sound knowledge
Knowledge of Cactus credentialing database
2.5 years of Facets and Xcelys experience
Contact this candidate