Customer Service Provider Enrollment
Resume:
Michael M. von Redlich
Manchester, New Hampshire 03103
******@*******.***
Philospohy: It isn’t enough to be in Customer Service – it’s about providing a POSITIVE Customer experience!
Summary:
• More than 30 years of experience in Customer Service, Sales and Account Management.
•Experienced representative providing customer service, with expertise in medical programs, enrollment and credentialing utilizing secure office computer systems.
Education: Huntingdon College, Montgomery, AL (1980-1983)
3 Years – Business Administration – No Degree
Prattville High School, Prattville, AL (1976– 1980)
4 Years – Business and Economics – Diploma Awarded
Experience:
Personal Leave of Absence
May 2023 to Present
Fulltime caregiver for Mother in final months - she passed in August- settlement of estate and personal time since then.
Provider Enrollment Maintenance Specialist
May 2022 to May 2023
TeamHealth – Knoxville, TN
•Complete all maintenance activities including research, recording, communication & information sharing, submission, confirmation and follow up
•Research insurance provider enrollment requirements by state.
•Creation and maintenance of CAQH practice and clinician profiles
•Submission of clinician updates e.g. licensure and certificates of insurance to payers
• Completion of any/all requests for data validation from payers and internal customers
• Manage roster submission, review and data entry
•Collaborate with colleagues to resolve enrollment related denials associated with maintenance
•Collaborate with analyst and/or HCFS to proactively monitor enrollment status for payers that require claim activity to remain participating
• Partner with Lead to communicate any form updates requires in AppGen
•Prepare and submit provider enrollment applications to insurance carriers.
•Follow-up on provider enrollment applications with providers, insurance companies or client sites
•Programs used: MS Office, Outlook, Excel, Power Point, MS Teams, PECOS, eVIPS, Allscripts, CMS, Digital Harbor, SalesForce, CAQH
Supervisor: Sandra Bakerick – Director, Provider Enrollment
Provider Enrollment Specialist
February 2022 to June 2022
Logixhealth – Bedford, MA - (Temporary Assignment)
•Process provider enrollment applications for providers/groups
•Research insurance provider enrollment requirements by state.
•Enter group/individual data to credentialing systems.
•Prepare and submit provider enrollment applications to insurance carriers.
•Follow-up on provider enrollment applications with providers, insurance companies or client sites.
•Experienced working with Medicare, Medicaid, and all major insurance carriers.
•Programs used: MS Office, Outlook, Excel, Power Point, MS Teams, PECOS, eVIPS, Allscripts, CMS, Digital Harbor, SalesForce
Supervisor: Lisa Higgins –Associate Director, Provider Enrollment
Provider Contract Specialist
August 2021 to February 2022
Mindlance – Contractor Assignment to
Amerihealth Caritas - Manchester, New Hampshire
•Confirms provider record in provider contracting system correctly aligns to contract and application documentation.
•Uploads contract documentation to contract management system.
•Tracks and communicates any provider data that cannot be aligned to contract documentation on a daily basis to management.
•Maintains strict confidentiality while meeting production quality and standards.
•Programs used: MS Office, Outlook, Excel, Power Point, MS Teams, PECOS, eVIPS, Allscripts, CMS, Digital Harbor, SalesForce
Supervisor: Sheila Jones –Manager, Contract Administration
Facility Recredentialing Coordinator
March 2020 to July 2021 (Assignment extended 6 times)
Mindlance – Contractor Assignment to
Cigna - Hooksett, New Hampshire
•Processing and verification of recredentialing applications.
•Review and process re-credentialing application for Medical Line of Business.
•Manage/Oversees centralized verification of current licensure and certification for Medical lines of business.
• Preparation and analysis of supporting documentation for review.
•Conduct thorough review of obtained credentialing information to ensure compliance with policy and regulatory requirements
Supervisor: Sophia Tsantoulis –Manager
Project Coordinator for NJ Small Groups
October 2019 to February 2020
Healthcare Support – Contractor Assignment to
United Healthcare - Hooksett, New Hampshire
•Processing and verification of applications from NJ small business groups
•Management of member databases and preparation of member outreach materials.
•Providing assistance and results for members regarding account maintenance, documentation, credentialing and general information.
•Preparation and analysis of supporting documentation for review
•Generation, collation and mailing of error reports to business groups
Supervisor: Tracey Bova –Manager
Executive Assistant to the Executive Director
April 2019 to September 2019
New Hampshire School Administrators Association –
Concord, New Hampshire
•Coordination and maintenance of Director’s Calendar
•Management of member databases and preparation of member outreach materials.
•Providing assistance and results for members regarding account maintenance, documentation, credentialing and general information.
•Preparation and distribution of research, reports and support for the Executive Board
•Preparation of awards, certification and grants for education professionals
•Administrative support to the Executive Director, Assistant Director, Special Education Director and Events Coordinator
Supervisor: Faith Wilson – Office Manager
Provider Enrollment Specialist/Team Lead
State of New Hampshire Medicaid Program
March 2017 to April 2019
Conduent (Formerly Xerox) – Concord, New Hampshire
•Receipt, processing and approval of Provider Medicaid applications
•Management of Provider service issues and resolution.
•Providing assistance and results for Providers regarding account maintenance, documentation, credentialing and general information.
•Research and resolution for Providers regarding issues relating to applications and documentation
•Security training and approval for use of PECOS, Digital Harbor and CMS Systems
•Supervisor: Kathleen Donovan – Provider Enrollment Manager
EZ Pass Account Specialist/Customer Care Representative,
September 2016 to February 2017 (End of Contract with State)
Xerox Corporation/Conduent – State of New Hampshire
•Guidance for customers with new applications for the EZ Pass Transponder Program
•Management of customer service issues and resolution.
•Providing assistance and results for customers with regarding account maintenance, violations, billing, tolls and general information.
•Research and resolution for customers regarding issues relating to fines and violations
•Daily financial audit and reconciliation according to State of NH regulations
•Supervisor: Kryste Raymond – Manager, State of NH
Mall Concierge and Sales
July 2015 to August 2016
Simon Property Group, Mall of NH. Manchester, New Hampshire
•Organization lead for driving sales, maintenance of gift card inventories and daily accounting.
•Management of customer service issues and resolution.
•Primary liaison for mall retailers and mall management communications
•Primary contact for growing membership and recruiting for Mall Kids Club Kidgits.
•Training of new associates with scheduling and delegation of duties.
•Supervisor: Kimberly Haffner – Director of Marketing
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Photography, Yearbook and Sales Representative/ Photographer,
August 1986 to July 1994 – July 2005 to June 2014
(Company Closed NH Offices)
Lifetouch National School Studios, Manchester, New Hampshire
•Responsible for driving and growing sales, booking of and school account retention in 167 accounts in 7 of 10 counties in New Hampshire.
•Management and organization of the delivery of portraits and yearbooks – primary customer service contact for issues and resolutions.
•Management for photography and yearbooks in accounts and delivery of portraits in same.
•Design, layout and student education with yearbook program.
•Supervisor: Rhonda Smith – Territory Manager
Photography and Sales Representative - August 1994 to June 2005 (Company Sold)
MacLean-Stevens Studios, Concord, New Hampshire,
•Sales and Portrait Photography in over 350 School accounts in 4 states.
•Responsible for customer service and overall satisfaction.
•Involved in marketing and school account incentive programs.
•Began as photographer and was promoted to sales position.
•Company sold to Lifetouch National School Studios in June 2005.
•Supervisor Blair MacLean (Owner)
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Additional Experience:
Theater Manager for Plitt Theaters and Cobb Theaters in AL, GA, FL, NC
Hotel Desk Clerk to Manager with Days Inn (Alabama and Georgia)
Hotel Desk Manager with Northside Hotel Suites (Atlanta, GA)
Credit Card Processing and Payment – Providian Bank Services in Concord, NH
Medicaid Claims Adjudicator with EDS in Concord, NH
Computer Program Skills:
Microsoft Programs including (but not limited to) Word, One Note, Outlook, Excel, Office
Theatrical Production Photography in Boston/Provincetown, MA, New York City, Concord and Manchester, NH
Partial List of Associations:
The Gold Dust Orphans, Boston, MA
The Oberon Theater, Cambridge, MA
Concord Community Players, Concord, NH
Theater 80 at St Marks, New York City, NY
The Majestic Theater, Manchester, New Hampshire
The Post Office Café and Cabaret, Provincetown, MA
Crown and Anchor, Provincetown, MA
Personal References:
Available upon request.
Contact this candidate