Lynn Gleich

**** ********* *******

Springfield, VA 22152

703-***-**** (home)

516-***-**** (mobile)

OBJECTIVE

To obtain an awarding growth opportunity in a stimulating and challenging medical environment that will enable me to utilize my work experience, education and skills.

EXPERIENCE:

Centene Corporation, Health Net Federal Services, Arlington, VA

Credentialing Specialist II

February 2021-Present

- Responsible for credentialing providers that belong to the Tricare Autism Care Demonstration program. Behavioral Analysts and Behavioral Technicians

- Responsible for provider credentialing and recredentialing in accordance with the appropriate URAC & NCQA standards.

- Responsible for collecting and checking the BLS/CPR and Background check to make sure they meet the Tricare requirements.

- Looking over the provider’s CAQH application and making sure that all the required Tricare elements are captured.

-Responsible for updating the expired States Licenses and Behavioral Analyst Certification Boards for the Behavioral Analysts.

National Spine and Pain Centers, Fairfax, VA

Credentialing Specialist

September 2019-February 2021

- Responsible for the providers in New York, New Jersey, and North Carolina locations.

- Responsible for provider credentialing and recredentialing in accordance with the appropriate NCQA & TJC standards.

- Responsible for completing credentialing and recredentialing forms for commercial and federally funded payers including Medicare and Medicaid.

- Responsible for communicating to practitioners their participation status with NSPC, commercial and government payers.

- Responsible for making sure that the provider’s licenses, DEA, CDS are current.

- Responsible for provider credentialing and recredentialing at hospitals and ambulatory surgery centers.

- Responsible for starting, updating, and verifying for each provider their CAQH application and Cactus.

Inova Health System, Falls Church, VA

Credentialing Coordinator

January 2012 September 2019

-Responsible for provider credentialing and re credentialing for Inova and CVO clients in accordance with the appropriate NCQA & TJC standards.

-Responsible for communicating to practitioners their participation status with Inova, commercial and government payers.

-Responsible for completing credentialing and re credentialing forms for commercial and federally funded payers including Medicare and Medicaid. Also compiling reports for delegated 3rd party payers on each provider.

-Initiates the CAQH application process for individual practitioners.

-Provides training and educating meetings and tools for new and current staff members.

-Responsible for reconciling monthly credit card statement for accounting purposes.

Inova Health System, Falls Church, VA

Credentialing Specialist

December 2010 January 2012

-Completed the credentialing and re credentialing process for commercial and federally funded payers including Medicare and Medicaid.

-Compiled spreadsheets for delegated 3rd party payers.

-Updated CAQH applications.

-Maintained medical staff credentialing for all five Inova hospitals.

-Communicated with providers and office managers to process an application to completion.

-Obtained primary source verification and adding the information into MSOW.

Rehabilitation Equipment Professional, Inc., Alexandria, VA

Medical Biller and Collections

August 2009 December 2010

Responsible for direct contact with new & existing customers for inquiries regarding new equipment orders and replacement parts of existing equipment. Verification of customers’

insurance information, benefits coverage, eligibility and certification/authorization requirements. Completion of all required state required state Medicaid forms. Responsible for timely, accurate submission of invoices to the responsible payer for services and products provided. Evaluate payments received and apply payments to the patient account. Follow-up with responsible parties to ensure the receipt of timely, accurate payments. Negotiate one time agreements with out of network insurance carriers.

Medical Resources, Inc., McLean, VA

November 2003 – April 2009

Med Tel International Corporation (acquired by Medical Resources, Inc.) Contracts Administrator, June 2006 April 2009

Administered and maintained third party payer contracts for 37 diagnostic imaging centers in 10 states. Maintained and distributed contract specific guidelines and information to imaging center staff and regional billing office staff. Completed credentialing and re credentialing forms for commercial and federally funded payers including Medicare and Medicaid. Obtained and updated payment rates in practice management systems. Assisted the billing office with contract and credentialing related accounts receivables issues. Negotiated case rate agreements with non contracted payers.

Team Leader, Insurance Verification

November 2003 – June 2006

Responsible for supervising a team of insurance verification representatives tasked with obtaining and verifying insurance eligibility and benefits as well as pre authorization approvals for services at 15 diagnostic imaging centers located in 6 states. Maintained personal caseload of 5 centers. Created and updated insurance codes in practice management system. Comprehensive experience in managed care, workers’ compensation, auto liability, Medicare and Medicaid program requirements.

CBCA Administrator Melville, NY

March 1998 – April 2003

Team Leader, Repricing

Responsible for examining and repricing medical claims through provider networks. Enhanced customer relationships by working closely with medical providers and hospital providers. Identified proper CPT 4 and ICD 9 coding. Tested and implemented new Onyx software program.

Prescription Drug Services

Hauppauge, NY, 1992 1995

Client Services

Validated and fulfilled prescriptions claims. Corrected rejected claims from various pharmaceutical services groups. Experience working with a large number of unions and other contracted groups processing prescriptions.

EDUCATION

Dover Technical School, Ronkonkoma NY, 1998, Medical Assistant Certificate

SUNY of Old Westbury, Old Westbury NY, 1987 1990, B.S. in Education

Suffolk Community College, Brentwood NY, 1983 1986, Associate in Applied Sciences

References available upon request

Contact this candidate