GLENDA L. WILSON

***** ********* *** #*

ad2ol1@r.postjobfree.com

Phone Number: 1-813-***-****

Credentialing Specialists Senior / DME Operator / Data Entry Operator / Customer Service Representative / Patient Care Coordinator

PROFESSIONAL SKILLS

Professional demeanor, strong written and oral communication skills, and ability to learn systems. Ability to use spreadsheet and database software required. Excellent in interpersonal skills; can effectively interface with internal and external customers, vendors and other credentialing staff. Administative Experence the demonstrates attainment of knowledge skills/abilities, preferably in a healthcare setting. Excellent in interpersonal skills and ability to effectively communicate both verbal and written with physicians and staff. Strong organizational and excellent follow up skills. Strong customer service skills, excellent communication, verbal and written. Excellent in following instruction. Proven patience and self-discipline. Personal and professional integrity. Relationships and team building. Sound decision making. Critical thinking proficiency. Government relations knowledge. Cultural awareness and sensitivity. Advance in communication and interpersonal / verbal and written skills. Advance into work as a member of a team. Strong knowledge in process documentation and government requirements. Presenting information and complying with responding to questions from members, and providers and staff. Knowledge of credentialing software and producing appropriate reports. Proven patience and self-discipline. Experience in an analytical role. Knowledge in medical terminology. Knowledge in medical billing practice. Knowledge in claims processing. Knowledge of provider maintenance and termination process. Licenses and Certifications.

PROFESSIONAL SUMMARY

My combined professional experience within the healthcare industry includes an emphasis in credentialing, quality management, health information management and education/training. My strong and numerous computer skill sets have given me the ability to succeed in many facets of the healthcare industry. Results-driven with expertise in all facets of Credentialing and DME Operator, Customer Service Representative, Data Entry and Patient Care Coordinator. Skilled in communication and collaborating with various members, to achieve service objectives. Consistently demonstrates the ability to provide excellent customer service and to utilize systems and investigating all incidents and escalating as needed.

·17 years experience in the Credentialing department.

·10 years of Customer Service and the Call Center.

·1 year in DME department.

·12 years in Data Entry with 12,000 Alpha and 15,000 Numeric. 50 words per minute in typing.

WORK HISTORY

Bristow Medical Center - 11/23/2019 - 12/10/2021. Bristow, Oklahoma

Job Title: Credentialing Specialist Sr.

·Job responsibilities: Receives and reviews submitted applications for completeness and compliance with instructions for preparation; ensures the timely completion of applications by communicating with and assisting the applicants in submitting all documentation necessary to process the application; identifies deficiencies and follows up to gather missing or incomplete data.

·Uses discretion and independent judgement in determining the need for deviation from standard processes or more detailed investigation, including those involving fees, or that would cause processing delays in order to clarify, verify and/or confirm information contained in the credentialing application.

·Perform primary and secondary source verification of Practitioner’s and facilities credentials according to policy.

·Performs the appropriate (applicable) credentialing processes in a timely and complete manner.

·Uses, protects, and discloses medical group patients’ protected health information (PHI) only accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.

·Responsible for processing provider and facilities applications and re-applications including initial mailing, review and loading into the database tracking system ensuring compliance with required standards.

· Ensures the files for clinicians and facilities due for credentialing/re-credentialing are available for review by the Credentialing Committee each month and resolves outstanding issues prior to committee review.

·Oversees primary source verification activities.

·Ensures timely processing of all credentialing requests.

·Perform outreach to providers and facilities via phone calls and fax/email correspondence.

·Responsible for audits and reports audit finding to the Credentialing Committee.

·Supports the Provider Relations, Credentialing Management, Quality Management and Regulatory Compliance with requested data reporting.

·Demonstrate respect and maintain patient’s and facilities dignity and confidentiality.

WellCare Health Plans, Inc. - November 2004 – 07/08/2019. Tampa FL

Job title: Credentialing Specialist Senior

·Job responsibilities: Overview of Position Processes high volume credentialing and recredentialing applications and/or enrollment of health care providers.

·Reviews applications, prepares verification letters and maintains databases.

·Contacts medical office staff, licensing agencies, and insurance carriers to complete credentialing and recredentialing applications.

·Ability to work with health care acronyms and able to differentiate between provider titles, download the providers applications.

·Meet productivity standards as outlined in client metrics.

·Identify any issues or trends and bring them to the attention of the management team.

·Understanding of credentialing process

·Familiarity with CAQH, DEA CSR Board certifications

·Verifying and auditing other employee's work

·Train other staff in credentialing.

·Auditor check staff work to go to review.

·Amenable for the development revision and institution of the policy and procedures.

·Facility and organizational files and reports.

·Facilitated and organized bi-weekly credentialing committee meetings for all major legal discrepancies and medical review.

·Review all legal discrepancy findings through the National Practitioner Data Bank (NPDB/HIPB).

·Improved current departmental processes for initial and re-credentialing turnaround time frame.

·Outreach to providers to ensure their timely renewal of expiring licenses and certifications.

·Credential and re-credential all nurse practitioners and physicians and facilities applications in accordance with The Joint Commission Providers.

·Staff Training, productivity.

·Tracking quality control and files auditing.

·Insurance credentialing processes.

·Adjusted compensable indeme

·Verifying Board Certifications, DEA, CSR, NPI, Practitioners Data Bank, Insurance, State and Federal OIG, Sam report for Medicare and Medicaid, Hospital privileging and onboarding process for new providers, Medicare OPT-OUT, entering all data into Cactus database, NCQA certifications, education and hospital privileges

Office Staffing – April 2003 – November 2004. Tampa, Florida

Job Title: Data Entry Operator

·Job responsibilities: Verification for the credentialing and recredentialing team which entails verifying DEA, CSR, Board Certifications, Site Surveys.

·Gathering, collating, and preparing documents

·Conducting research to obtain information for incomplete documents and material.

·Reviewing all documents and information for accuracy.

·Training staff in primary sources.

·Training in credentialing.

·Collecting data and input to spreadsheets and data bases

·Support including data entry, filing, copying, scanning, faxing is required.

Pierce County Services - March 1985 - February 2003 Tacoma, Washington

Title: Computer Operator / Data Entry Lead.

·Job responsibilities: Gathering, collating, and preparing documents

·Conducting research to obtain information for incomplete documents and 6376-glendawilson39@gmail.com6376-glendawilson39@gmail.com6376-glendawilson39@ad2ol1@r.postjobfree.com.

·Reviewing all documents and information for accuracy.

·Monitoring of systems and networks.

·Monitoring of the security and facility environment.

·Interacting with System Administration staff to report and resolve issues.

·Using a variety of tools and processes to determine the health of the systems and networks.

·Applying fundamental concepts, processes, practices, and procedures to technical assignments.

·Executing and monitoring a range of scheduled routines.

·Resolving common operating problems.

·Diagnosing and acting on computer output instructions and machine stoppage or error conditions.

·Applying standard operating and or corrective procedures.

EDUCATION

Woodrow Wilson High School - Graduated in 06/1975 high school diploma. Tacoma, Washington.

Tacoma Community College - Child Development and Business Machine, Sociology – June 1974. Summer School. 3 credits Tacoma, Washington

Bates Community College - WordPerfect and Excel Microsoft Word June 1976 2 credits. Tacoma, Washington

Hillsborough Community College - English, Basic Computers, Algebra, Business and Registered Nurse 2009 – Present. 4 credits. Tampa, Florida

PROFESSIONAL TRAINING

Patient Care Coordinator Training - 10/2022 to 12/2022

·Performs routine data entry tasks.

·Conducts insurance verification, coordination of benefits, co-pay collection.

·Provides pricing, availability, and schedule information.

·Performs specialty and retail order scheduling.

·Effectively triages patient may have questions and needs to the appropriate staff member on the Pharmacy Team.

· Provides excellent customer service as evidenced by a willingness and ability to assist customers with their questions/concerns, treating customers in a friendly and helpful manner, and maintaining a positive attitude.

·Upholds patients’ rights including privacy and confidentiality.

·Operate effectively in a fast-paced deadline-driven environment that requires attention to detail and the ability to multitask.

·Performs other duties as assigned.

·Provides excellent customer service as evidenced by a willingness and ability to assist customers with their questions/concerns, treating customers in a friendly and helpful manner, and maintaining a positive attitude.

·Upholds patients’ rights including privacy and confidentiality.

·Operate effectively in a fast-paced deadline-driven environment that requires attention to detail and the ability to multitask.

·Performs other duties as assigned.

PROGRAMS

IntelliCred, Omni, Citrus, MedPro, Optum, Gensis, and Navigator, WWIKT, Iris, Excel, Optum, Alorica Connect, Grid, Alorica ECFR, EIS, Engage, Alorica on Point, Avaya, Oracle, Service Now, Spectrum Kiosk, Spectrum Staff, Teams, Knowledge, Del Set-Up, Genesis,Intermediate in Cactus, Intermediate in Microsoft PowerPoint,Intermediate in Access, Paradigm,Diamond EMMA, IBPS, Omni, VPN, Cactus, IRIS, QNXT, PRMS, Excel, Word, Power Point, PECOS, NPPES, CAQH, NCQA Accreditation.

Certifications

Certified - Care Coordinator 11/20/2022 from Alorica Omaha, Nebraska

Certified – Certified Professional Credentialing Specialist 10/15/2012 from WellCare Health Plans. Tampa Florida

Contact this candidate