Director of Provider Credentialing

Sherri Valentine

**** ******** ********

Kernersville, NC 27284

336-***-**** Home - 336-***-**** Cell

act7ut@r.postjobfree.com

OBJECTIVE: Resposible position in provider credentialing/medical billing field

EDUCATION: BA in Medical Administration Technology, ECPI (Greensboro), 2004

GPA 4.0

EXPERIENCE: Director of Provider Credentialing

Healthcare Business Services (HBS), High Point, NC; 2004 to present:

Primary Responsibility: Assuring credentials of medical providers (doctors, nurses, anesthesiologists, etc.) are properly filed with insurers to assure prompt accurate payment of medical claims. Currently serving 35+ provider clients (clinics, hospitals, surgery centers, etc.), coordinating with payers including Medicare, Medicaid, Department of Labor, Tricare, and several private insurers.

Secondary Responsibilities: Client liaison including sales and initial account setup (defining services and benefits, client training, setting up banking/EFT, etc.); defining client reporting needs; designing and delivering custom reports (A/R, financial class breakdowns, patient data, etc.); and problem-solving as needed. Aiding clients with license verifications, certifications and enumeration needs. Tracking client payments, taking action to collect if needed; following up with providers for missing patient and/or provider information; overview of the credentialing and billing processes, trouble-shooting as needed to assure things run smoothly. Maintaining good working relationships with Medicare entities in several states (such as TrailBlazers, Novitas, CIGNA, WPS, Palmetto GBA, Cahaba, and the old Tricare intermediary-HealthNet Federal Services). Assuring compliance with HIPAA, NPI (NPPES), CAQH and other agencies. Processing W-9, CP-575, LTR-147C, HCFA-1500 and various other documents. Processing incoming mail to assure proper distribution of documents and resolution of problems.

Prior Responsibilities: Data entry, including tracking down missing data, creating patient and client accounts, posting payments to proper accounts, maintaining monthly account ledgers. Coding for data entry, including ICD-9 (diagnosis), CPT (procedure), and ASA (anesthesia) codes.

Skills:

Proficient use of Excel, Word, Windows, and Medical Software Specialties (MSS) software, among others. Setting up client UPSCampusShip accounts. Use and troubleshooting of postage machine and two large Kyocera Mita printer/copier/fax machines. Great organization skills, from keeping personal work area in order to creating effective and efficient workflow processes, designing functional office layouts, and maintaining optimal just-in-time inventories of supplies for our use as well as for clients.

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