TERA RANDALL

OBJECTIVE

SKILLS

Seeking a position in healthcare where I can bring my rich experience in patient care, provider/patient customer service, knowledge in front office support, financial federal/state funding resources and incentive programs, and skill in navigating managed care sources in order to provide the best customer experience

Front Office Representative, Back Office Representative, Research, Appointment Scheduler, Insurance Verification, Credentialing Verification Unit, Trainer

Computer program knowledge in Microsoft Word, Excel and PowerPoint, Windows 98, 2000 and XP, Outlook, Lotus Notes, EPIC, Echo, MD Staff, Meditrac, HSP

Strong Organizational Skills and Ability in Multi-taskingd and Prioritization

Strong Problem Solving and Decision Making Skills

Detail Oriented

Excellent Customer Service and Communication Skills

EXPERIENCE

09/2016 – Current Christus Health Irving

Senior Credentialing Coordinator - Lead

Identifies departmental needs and leads staff in development and educating all credentialing associates on new processes and procedures.

Revise policies and procedures governing the CVO

Train new associates and remaining a resource for questions or concerns.

Troubleshoots errors with the credentialing system

Oversees and manages workflow and file assignment to credentialing staff

Assist with annual policy audits and file audits for delegated groups.

Performs Credentialing and re-credentialing for physicians, allied health professionals, and facilities/ancillaries for the CVO.

Obtains additional information for applicants and reapplicants if factors are revealed that may impact quality of care and/or tabled after peer review at the Credentials Committee

Collaborate with all other departments as appropriate to complete goals.

Serves as liaison between CVO, vendors, and conjoining departments as it relates to credentialing requests.

Audit provider records for completeness and accuracy and ensuring compliance with NCQA, URAC, TRICARE, CMS, and state regulatory standards.

Completes additional projects and tasks as necessary.

09/2013 – 09/2016 Blue Cross Blue Shield Richardson

Credentialing Representative II

Maintain recredentialing for in-network practitioners within required timelines

Ensure recredentialing policies and procedures are adhered as they relate to assigned functions

Review and accuracy in recredentialing files for completeness and loop closure

Maintain business relationship and correspondence with providers and customer case

01/2012 - 09/2013 Federal Reserve Bank Dallas

Call Center Customer Service Representative

Providing Customer Service Assistance related to daily banking needs with opening accounts and direct deposit

Maintaining and verifying patient applications and information within the customer database

Assisting in Special Project opportunities to improve daily banking operations

07/2008 – 08/2010 Children’s Medical Center Dallas

Care Coordinator Assistant

Indentified patients to be completed in MIDAS system and appropriate discharge documentation under direction of the Care Coordinator

Ensured timely transfer of pertinent patient information to third party payers

Assisted Care Coordinator with appeal and denial process

Arranged for durable medical equipment and coordinated and scheduled home health needs

Arranged PCP/specialty appointments

Collected data at the direction of the CRM department director or team leads

07/2006 – 06/2008 Baylor Geriatric Center Dallas

Healthcare Representative

Receptionist duties and scheduled appointments

Pulled face sheets, printed labels, verified patient information, and scanned insurance cards

Verified all medical records are in chart from referring physician and forms are signed and completed

03/2003 – 07/2006 Baylor University Medical Center Dallas

Patient Care Tech/Unit Secretary

Assisted RN’s, made hourly rounds, and provided adequate comfort and care to patients and family

Checked vitals and diabetic finger sticks

Assisted with bed changes, AM care, and dressing changes

Assited with lab collections, catheter care and removal, and removed IV lines

Assisted with discharge preparation

EDUCATION

11/2014 – 05/2018 National American University Richardson

Medical Assistant

Medical Transcriptionist

09/2010 –1 0/2012 Dallas Nursing Institute Dallas

08/1998 – 05/2002 Skyline High School Dallas

High School Diploma

ad2j0y@r.postjobfree.com

1314 ARBOR VITAE AVE • DALLAS, TEXAS • 469-***-****

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