Manager Customer Service
Resume:
Holley M. Gruenwald
Cincinnati, OH 45211
Phone: 513-***-****
******.*********@*****.***
Motivated and organized Credentialing Coordinator with over ten years of credentialing experience. Great attention to detail in every project. Very thorough in follow up. Currently looking for a remote credentialing position.
Work History
March 2014 – Present
Supero Healthcare Solutions, LLC
Job: Credentialing Project Manager
Responsibilities: Contracting and provider enrollment for all practices (new and old) with commercial medical/dental/behavioral health plans, Medicare and Medicaid enrollments. Hospital privileging and reappointment. Recredentialing and revalidation applications for all payors. Provide follow up reports on the status of all enrollments to practices and/or providers. Updating and maintenance of CAQH and NPPES. CAQH and NPPES set up for providers. Ensuring that all documents on file are up to date and current.
January 2013 – March 2014
Riverhills Healthcare, Inc.
Manager: Jeff McGuire
Job: Credentialing Coordinator
Responsibilities: Neurology practice. Ensuring that all providers are enrolled with all payers that we are currently contracted with. Requests for new contracts with any payers that we do not currently have a contract in place with. Initial hospital privileging applications. Reappointment applications for all providers. Initial and re-credentialing applications for all insurance companies for all providers. Familiar with credentialing of the following insurance companies: Aetna, Anthem, AmeriGroup, Cigna, CareSource, Coventry, Coventry Cares of KY, HealthSpan, HealthNet Federal Services, Humana, KY Medicare, OH Medicare, Medical Mutual of Ohio, Molina, UHC, WellCare of KY, Wellcare Medicare, Medicaids (Ohio, IN, Kentucky, West Virginia, Florida, North Carolina). CAQH set-up and maintenance. License and DEA renewals or updates. Assisting new providers with initial license applications in Ohio and Kentucky. Ensuring that a current and active license and DEA is on file with all insurance companies and hospitals. Maintenance and update of malpractice insurance when needed. Assist with claims resolution when denials are received. Ensuring that a current TB test is in providers file. Assisting with billing projects when needed (i.e. Collection Write Offs, voided office visits, verification of underpayments, etc.) Assistance with patients for claims issues, confirm for them that their provider is in-network, and any questions regarding insurance types that our providers see in the office. Development of a fee schedule spreadsheet with all current insurance payers for billing department staff. Familiar with credentialing of Neurology, Neurosurgery, Pain Management, Rehabilitation, Behavioral Medicine, Physical Therapist, and Physician Assistants. Implemented a spreadsheet for billing, scheduling and front desk associates for all plans with participating insurance companies and which specific plans require a referral.
June 2012 – December 2012
Hometown Urgent Care
Manager: Sonya Olsezswki
Job: Credentialing Coordinator
Responsibilities: Ensuring contracts are in place for all insurance companies with all locations and all providers listed. Ensuring that NPI login information is on file for all providers. Meaningful Use implementation setup for all providers. CAQH maintenance. Enrollment of all locations and providers with OH, KY, and IN Medicare/Medicaids. Terminal Distribution Drug licenses for all offices. Controlled substance license registrations for all providers. DEA and License renewals when needed. Changing of group names and applications for all new group numbers and set up of all locations and providers with new group information. NPDB and AMA profile requests for new providers. Primary source verification of education, references, employment, etc. Familiar with credentialing of Internal Medicine and Emergency Medicine.
April 2008- June 2012
UC Physicians, Inc.
Manager: Lisa Hunt
Job: Credentialing Coordinator
Responsibilities: Credentialing for 148 providers (Doctors, Nurse Practitioners, Physician Associates, Nurse Midwives), maintain records of licenses and certifications, all paperwork with hospitals and insurance companies for initial appointments and reappointments. Maintain spreadsheets and databases of all provider numbers, expiration dates, license numbers, DEA registrations, etc. Assist billing department in indentifying why claims deny. Credentialing of all major insurance companies as well as various others. Familiar with hospital credentialing at University Hospital, The Christ Hospital, Tri Health facilities, Mercy facilities, University Pointe, West Chester Medical Center. Updating CAQH and SyMed (One App) program when new provider numbers are assigned, or reappointment dates change. Familiar with credentialing of the following specialties: Surgery, Ophthalmology, Dermatology, Obstetrics and Gynecology, Orthopaedics, PM&R, Neurology, Behavioral Medicine, Dental, Internal Medicine, Nurse Midwives, Physician Assistants, Nurse Practitioners and CRNA’s.
December 2005 – April 2008
Cranley Surgical Associates, Inc.
Manager: Emily Gillum
Job: Surgery Scheduler/Credentialing Specialist/Appointment Scheduler
Responsibilities: Schedule surgeries for patients, Pre certification & pre determination for surgeries, recall letters, credentialing for 9 doctors and 2 Nurse Practitioners with all insurance companies and hospitals, applying for licenses, DEA’s and hospital privileges. Maintaining expiration dates and ensuring that all documentation is up to date. Misc. projects for the billing office, help in medical records when needed, schedule office visits and scans. Answer incoming calls to schedule appointment, make phone calls to schedule appointments, call patients to confirm surgeries, pre-certification for inpatient & outpatient procedures, making copies, revising handbooks, procedure books, checking in patients, organizing medical records, recall letters. Familiar with credentialing of Vascular and General Surgery, Physician Assistants and Nurse Practitioners.
December 2005 until February 2006
Superior Automotive (Acura & Hyundai)
Manager: Barb Martin
Job: Cashier
Responsibilities: Answer incoming calls, ring up service/part customers, bank deposits, temp tag applications, receipt in money for car purchases
September 2004 until December 2005
Jeff Wyler Honda of Colerain
8950 Colerain Avenue
Cincinnati, Ohio 45251
513/741-3700
Manager: Jenny Randolph
Job: Cashier/Receptionist
Responsibilities: Answer phones, greet customers, customer service, ring up customers, bank deposits, office work
April 2004 – September 2004
Gap in employment because I was attending Basic Training and Technical School for the United States Air Force in San Antonio, Texas.
March 2002 until April 2004
Jeff Wyler Honda of Colerain
8950 Colerain Avenue
Cincinnati, Ohio 45251
513/741-3700
Manager: Jenny Randolph/Judy Eggers
Job: Cashier/Receptionist
Responsibilities: Answer phones, greet customers, customer service, ring up customers, bank deposits, office work
MILITARY EXPERIENCE
December 2003 until March 2008
United States Air Force Reserves
Youngstown Air Reserve Station
Wright Patterson Air Force Base
EDUCATION
Roger Bacon High School
4320 Vince Street
Cincinnati, Ohio 45214
Diploma: College Prep course work
Graduated: June 6, 2003
Cincinnati State Technical and Community College
Cincinnati, OH 45223
Degree: Health Information Management
Anticipated Graduation Date: 5/2015
Precision Nutrition
Level 1 Precision Nutrition Certification
June 2016
ADDITIONAL SKILLS
-Experience with Microsoft Office programs.
-Internet Explorer
-Typing: 76 wpm
-Data Entry
-Filing
-Multi-line Phone system
-Organized
-Detail-oriented
References available upon request.
Contact this candidate