Customer Service Medical
Resume:
Michelle Ricketts
************@***.***
Lakewood, CA 90715
310-***-**** cell
Profile: Organized professional seeking a Coordinator position utilizing my excellent office skills by performing strong communication and customer relation skills, as well as conducting thorough data analysis to contribute to the success of my employer.
Career History:
IPC Healthcare: 11/2014 – 4/2015
Credentialing Specialist
Review and analyze credentialing documents including education, residency and fellowship training, board certification and eligibility licensure, professional work history, liability insurance and requested for clinical privileges and malpractice history
Process Medicare, Medical and Medicaid credentialing applications for various geographically diverse regions
Responsible for resolving various credentialing log issues and process write off request
Liaison between the central business office and the regional credentialing members for various problems and issues
Perform verification of out of state Medicaid eligibility for specific date of service
Request Facility Site Review (FSR) as a condition of participation for the provider to meet the quality improvement standards and ensure compliance with applicable local, state, and federal laws and regulations through the National Committee for Quality Assurance (NCQA)
Ensure that the (FSR’s) are conducted during the initial provider credentialing process, and verify their training for board certification and run reports
Assesses that the site reviews are conducted as part of the ongoing provider re-credentialing process to assure that each provider continues to meet quality standards
Identify and flag adverse information from provider application materials for the purpose of conducting special follow up investigations
Assesses completeness of information and providers qualifications relative to established standards, and review all provider credentialing and re-credentialing applications for completeness
Data enter mailing and tracking for all providers
Follow policy and compliance schedule for sending request prior to credentialing expiration date, and initiate follow up calls according to policy and update new information as received via re-credentialing process
Prospect Medical Group: 04/2014 – 07/2014
Credentialing Specialist Temporary Assignment
Reviewed and analyzed credentialing documents including education, residency and fellowship training, board certification and eligibility licensure, professional work history, liability insurance and requested for clinical privileges and malpractice history from Gemini/Cactus database
Requested Facility Site Review (FSR) as a condition of participation for the provider to meet the quality improvement standards and ensure compliance with applicable local, state, and federal laws and regulations through the National Committee for Quality Assurance (NCQA)
Ensured that the (FSR’s) are conducted during the initial provider credentialing process, and verified their training for board certification and run reports to verify that there are no pending claims filed
Assessed that the site reviews are conducted as part of the ongoing provider recredentialing process to assure that each provider continues to meet quality standards
Identified and flagged adverse information from provider application materials for the purpose of conducting special follow up investigations to present to the committee
Assessed completeness of information and providers qualifications relative to established standards, reviewed all provider credentialing and recredentialing applications for completeness
Data entered mailing and tracking for all providers
Followed policy and compliance schedule for sending request prior to credentialing expiration date, and initiated follow up calls according to policy and update new information as received via re-credentialing process
Healthcare Partners: 05/2005 - 08/2012
Contract Coordinator
Developed relationships with clients and professional service providers for prospective referrals
Assessed and completed provider contracting needs for all provider operations, resolved claims issues, coordinated with various departments and managed proper administration of contracts
Prepared supporting documentation and maintained contract by providing a comprehensive network of providers in geographically diverse areas
Coordinated the completion of provider pre-contractual information and gathered, and consolidated provider data from various sources
Managed the integrity of data in database and verified accuracy of provider information
Ensured provider adheres to contractual agreement
Demonstrated communication skills and commitment to superior customer service and maintained client relationships
Reviewed and analyzed credentialing documents including education, residency and fellowship training, board certification and eligibility licensure, professional work history, liability insurance, request for clinical privileges and malpractice history
Assessed completeness of information and providers qualifications relative to established standards, reviewed all provider credentialing and re-credentialing applications for completeness
Determined appropriate verification and reference letters to be prepared for adequate processing of each individual application and reapplication
Requested facility site reviews from appropriate source on applicable providers
Responsible for the generating, mailing, tracking, and provider re-credentialing applications
Followed policy and compliance schedule for sending request prior to credentialing expiration
Initiated follow up call according to policy and updated new information as received via re-credentialing process
UCLA Medical Center: 02/1999 - 05/2004 Administrative Assistant III
Coordinated the front office by preparing and sending packets to all new patients; compiling charts for new patients and insuring that charts were pulled for the next day schedule
Supported all administrative functions for the clinic by following policies and procedures including managing the physicians schedules in the scheduling software system
Supported patient appointment schedule by placing calls to patients who need appointment notification or reminders, including time, date and address/directions to the Multi-Specialty clinic
Demonstrated leadership skills through flexibility in accepting schedule and work assignments
Exercised proper discretion with sensitive information and the use of medical terminology
Effectively handled multiple tasks by collecting office co-pay, processed fee tickets, performed insurance verification and prepared referrals to the specialist
Handled large volume of inbound and outbound calls
Documented all patient specific information in appropriate database system
Handled HMO, PPO, Medicare, workers compensation and third party payer plans
Acted as a resource and provided guidance to new employees, offering assistance and direction to less experienced team members
Interacted effectively with all levels of personnel and collaborated with staff and management
Performed data entry, created medical charts, filing, scanning and copying
Education California State University Dominguez Hills Graduated May 2012 Bachelors of Arts Degree: Public Administration
Interdisciplinary Studies (Minor)
Skills: Medical Terminology certificate, Microsoft Word 2012, Excel 2013, Outlook, IDX, People Soft, Citrix, Cactus, Gemini Diversified, CRDA, Typing, Filing, Scanning, Documenting, Sorting, Database, Reports, Payment and Posting, DTS Codes, Insurance Codes, Claims, knowledgeable of PTAN’s, Taxonomy, Pecos, Medicaid and Medicare Attestation
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