Resume of Deneen Carpenter

Proficient in Insurance verification, Authorization verification & Prescription Pharmacy Status.

She has experience of handling over 75 calls per day. Typing speed is 45-50 words per minute.

Efficient in handling Member Escalation Calls,

Payments, Enrollment Applications APTC,

Credit Card verifications,

Provider Relations, Referrals for members needing specialists & Urgent Doctor Appointments.

PROFESSIONAL EXPERIENCE:

Bay Mark Health Services-- April 29-22- September 21- 22- (Contract Assignment)

Facility Application Credentialing Coordinator- Specialist-

Submit applications to Medicare via PECOS,

Medicaid application per state requirements

Commercial Payer Applications- BCBS, AETNA, Superior, HUMANA, etc.

Opioid Treatment Program Facilities applications

OBOT Office Base Opioid Treatment Centers

Coordinate and compile the applications with supporting documents per the specification of the payer.

Insure the providers education and licensing is current and ready for submission.

Set up Portal log ins when applicable.

Update CAQH information and flag the renewal of documents before expiring. (Every 90 days due but 10 days prior for on time submissions)

Follow up calls to the provider for the application to be signed and documented as the state requirements instruct.

Initiate new application and or renewals for documents to make sure that are in good standing for the assignment we are enrolling in.

Updating Excel spreadsheet for weekly meetings with leadership to show status of all pending providers as current or pending with the application.

Parkland Hospital 09/2021 – 4/26/22- (Contract Assignment)-Admin/MSC (Contract) Daily duties consist of Verification of Providers using various licensing database.

Pathway Learning Modules

Notation of Systems when provider searching Zoom Verification meetings Demographics updates using PSV Spreadsheet updates.

Weekly Team-meetings Web punch Time Keeping MD Staff Credentialing daily updating and logging of documentation received

Doc U Sign submissions

OPPE support of file gathering and composition and updating in MD staff.

Excel project completions, Email responses, Web meetings, Zoom meeting with providers.

Review healthcare providers’ submitted requirements including licensure, certifications, screens and other critical documents using the data platform system to determine healthcare provider (HP) document status versus requirements needed for specific assignment in order to pursue outstanding requirements.

Communicate timely updates of HP document status with all internal stakeholders via the data platform system, email, phone, etc. to facilitate a team approach to gathering all required documents.

Create urgency with healthcare providers via email and phone, to encourage timely and accurate document submission by establishing target dates and monitoring document submission progress in order to deliver comprehensive documentation to the client facility for an on-time assignment start date.

Coordinate response to assigned client regulatory audits, TJC/TWSM/NCQA documentation, and other requests by client facilities by completing the requests with accuracy and within the established/provided timelines.

Coordinate with 3rd party vendors to determine appropriate dates, times, and locations for HP candidates to complete necessary compliance steps including drug screens, background checks, immunizations, etc.

Facilitate quick book (QB) process for assigned facilities by taking lead role to collaborate with Account Managers, Recruiters, and the Housing department in order to determine reasonable start dates.

Collaborate with Contracts Credentialing Analyst to review all incoming new client contracts or contract revisions for Credentialing requirements, for assigned facilities in order to identify unique requirements.

Negotiate with client facility to reconsider unusual or uncustomary requirements by emphasizing the value and experience of Quality Services Department with client facilities in order to minimize disruption of placements and optimize fill rate.

Consult clients on Credentialing best practices by making recommendations on requirements expectations and realistic start dates to streamline submission and placement processes in order to increase fill rate of qualified HPs.

Maintain up-to-date and accurate facility database including updated contact information, new requirements, and client correspondence by following up regularly with clients in order to optimize service coverage and prevent gaps in service delivery.

Research new requirements (by The Joint Commission, OSHA, and others) that may impact the industry in order to present proposals to leadership that clarify appropriate action plans that will address the requirements with the least resources and expense.

One Share Health 03/2020 - 08/2020- (Contract Assignment) - Insurance Verifications and Eligibility Systems used on a daily Basis: I solved, LOOMIS, NX Sonic Wall Extender, Nice Scheduling for Scheduled breaks and lunches. Ring Central for Remote log in. Bill Overview with Members, Status for Missing Documentations for Finalized Bills. SharePoint System logging Escalation calls and follow up tasks in Admin 123 Noting systems. Tasks Researching Cancellations Member ship requests. Bill Submission in directing UB04 forms and CMS 1500 guidance on completing a bill.

Molina Health Care 09/2019 - 03/2020 Second Tour for Medicare Enrollment (Contract Assignment) Insurance verification: Authorization verification: Prescription Pharmacy Status. Member Escalation Calls. Payments: Enrollment Applications APTC credit verifications. Provider Relations Referrals for members needing specialists. Urgent Doctor Appointments.

Exact Sciences Laboratories 04/2019 - 09/2019 Cologuard (Contract Assignment Madison WI) Incoming providers looking for lab results for patients. Incoming providers calling to give incomplete order information ICD codes, Patient demographics, Billing information, Lab Results. Transferring patients to patient lines. Educating on the order process with Medicare Guidelines, noting every call, setting up next process task within Epic task system. Researching results with the last 3 yrs for future rescreening. Faxing lab results to secure fax lines Positive Negative- SCNBP- NRP. Giving verbal results over the phone after HIPAA verification- has been completed. Instructions on how to recollect if done incorrectly. Instructions on how to order on our portal, instruction on CG requisition processing. Pecos verification, NPI verification, Provider submitter verification. Health Organization verification Reprocessing incorrect claims. ICD code corrections within the indicated exact corrected code. Processing incorrectly submitted claims. ICD corrections. EPIC Healthcare system notations entered with instructions directing you to make the correction with the correct code with extensive notation of the correction and claim details.

Walgreens Distribution Drugs Returns 03/2019 – 09/2019 (Contract – Weekends only 2nd job Madison WI) Scan returned prescriptions that are expired and out dated drugs. DEA verification background clearance granted. Quantity data quota hourly. QA analysis of daily entry of rework completed if applicable.

Cardinal Health 04/2018 – 02/2019 Pharmacy Intake Clerk- (Contract Assignment)

Intake Pharmacy orders from patients of transplants of all kinds.

Place prescription orders, process shipment orders, Verify patient demographics of the shipment address.

Place overnight shipments with Fed EX.

Trace any shipments that were not received from the patient.

Contact any providers for new prescriptions for the patients who prescriptions that have expired.

Small Business Administration 09/2017 – 02/2018 Administration Support

Application Processing date and time stamped loan applications from FEMA.

Office of Disaster Assistance Management. Hurricane Harvey, Irma, California Fires, and all other floods.

Create and update loan files in the oracle program, Disaster Credit Management System (DCMS) for disaster loan victims.

Document incoming mail and correspondence received by applicants in Disaster Credit Management system. Consult NEMIS, the database of the Federal Emergency Management Agency (FEMA), to assist with clarifying documentation for application entry purposes.

Contact applicants in regards to missing and/or questionable information on their applications and other correspondence.

Multi-tasking, performing face pace work with limited supervision producing quality work. Cross trained in other departments such as Quality Assurance, ELA department, 8821 for Reconsideration, Incoming Mail, and Summary Decline department qualifying applicants for Summary, Decline Worksheets located in the DIG (Disaster Assistance System).

Application entry Processing applications to create a complete status of approved applications with Small Business Administration.

Referencing (when applicable) the database using Nemis (National Emergency Information System).

DCMS (Disaster Credit Management System) monitored through Field Ops Query Software System). Complete Microsoft Excel Software Package daily production sheet.

Contacting applicants for missing documents in assisting borrowers to close their loans Counseling home and business applicants on the documents required.

Tenet Healthcare 04/2017 – 09/2017- (Contract Assignment)

Credentialing Specialist Credentialing specialist for Tenet Healthcare. Processing applications for providers.

Molina Healthcare 11/2016 – 04/2017 Member Service Representative II (Contract Assignment) Insurance verification: Authorization verification: Prescription Pharmacy Status. Member Escalation Calls. Payments: Enrollment Applications APTC credit verifications.

American Anesthesiology 11/2015 – 07/2016 Provider Enrollment Specialist

Enroll providers into insurance network

Medicare, Medicaid, Commercial

Adhere to CMS guidelines- for all supporting documents of education and licenses required for the enrollment to be completed.

CAQH database maintenance – Compile the file for the providers sending out FED Ex- Envelopes with the application and Checklists. Inserting a second return FED EX envelope to have the provider to return the signed application within 72 hours. Assist them with making sure the application is clean and will process through to committee with no issues.

EMSI, Inc. 10/2014 – 03/2015 Medical Case Manager (Contract Assignments)

Responsibilities Auditing medical records cases for Medicare Fraud.

Producing specific Date of Services request per Medicare Audits for DOS verification. Accomplishments Top medical records retrieved in one month’s time.

500 cases at no cost for insurance company. Medical Records Retrieval.

Small Business Administration 12/2012 - 04/2013 Administration Support Assistance/PDC/Processing Assistant Create and update loan files in the oracle program, Disaster Credit Management System (DCMS) for disaster loan victims.

Document incoming mail and correspondence received by applicants in Disaster Credit Management System. Consult NEMIS, the database of the Federal Emergency Management Agency (FEMA), to assist with clarifying documentation for application entry purposes.

Contact applicants in regards to missing and/or questionable information on their applications and other correspondence. Multi-tasking, performing face pace work with limited supervision producing quality work. Cross trained in other departments such as Quality Assurance, ELA department, 8821 for Reconsideration, Incoming Mail, and Summary Decline department qualifying applicants for Summary Decline Worksheets located in the DIG (Disaster Assistance System).

Application entry Processing applications to create a complete status of approved applications with Small Business Administration. Referencing (when applicable) the database using Nemis (National Emergency Information System).

DCMS (Disaster Credit Management System) monitored through Field Ops Query Software System). Complete Microsoft Excel Software Package daily production sheet. Dallas: 4400 TX-121 STE 300, Lewisville, TX 75056 Fort Worth: 5049 Edwards Ranch Road Fort Worth, TX 76109

Contacting applicants for missing documents in assisting borrowers to close their loans Counseling home and business applicants on the documents required.

Humana-Lifesynch Mental Health Division

January 13, 2007 to July 23, 2012

Credentialing Specialist for Hospitals & Solo practice Providers

Contract doctors and Hospitals for Humana Insurance, bringing them into network with Humana and Medicare. Duties included processing application requests for credentialing with Humana and Medicare.

Researching any missing contract materials needed for the complete credentialing process, faxing, and mailing, email contractual documents to providers for the credentialing application process.

Legal contracts are explained and negotiated salaries with providers with territorial needs of the members. Conversions are done to better serve areas where members are populated for Humana and Medicare.

We request missing documents and materials from the providers.

Verified credentials of providers including: licensure, Insurance coverage, Diplomas, Backgrounds, Hospital practicing privileges and any legal infractions current or past on the record of the provider.

Access information referenced in the COP’s database (Credentials of Participating Providers) & Dimensions database system where (location demographics of all providers) that are practicing.

We track the progress as the applications are being processed and credentialed. We researched licensing materials currently in the CAQH database (Counsel for Affordable Quality Healthcare) database. This contains private information of the providers and all current documents held by the providers.

We submit Facilities contracts, Group contracts and Solo provider contracts who are joining the network.

System updating for all licensing and education needs to submit a clean application to clear with committee.

Skillset:

I enjoy provider enrollment as a full cycle salaried employee from Humana. I have recruited placing providers in fileable and saleable areas. I have negotiated fee schedule contracts for them using Medicare Medicaid and Commercial rates. Lastly, I have completed the application of all of the supporting documents needed to submit to the committee bringing them onboard with a clean slate adding to the company staff per specialty of Medical Mental Health lower level and upper level providers.

Yes, as I know the full cycle of enrollment process using my skillset and adding with it as revenue cycling researching claims that did not pay referencing the fee schedules for contracting. This locates whether or not the provider was contracted initially with specific CPT codes reducing the possibility of claims denying at the end do to this error of credentialing.

No formal certification, as experience comes with on the job training. Certification give the explanation that you have the process down with no experience behind it. I have the skillset down and process with on the job training as they implemented in the 1980's. My era of office skills of shorthand typing dictation, 10 key. Brought to surface with Humana for 7 years of full cycle implementation of provider networking. Medicare Medicaid commercial payers.

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