CINDY

BOGLE

*** ******** ****** ** ********* TN 37209

615-***-****

ad3aft@r.postjobfree.com

OBJECTIVE

To work in an environment where I can utilize my skills to work hard, learn & grow within a company.

Skills

Customer Service

Billing/Coding

Credentialing

MS Office Products

Claims/Managed Care

Provider Enrollment

Team Player

Management

Multitasker

EXPERIENCE

Assistant General Manager Planet Fitness (Current Job)

August 2022 - Present 1 years Nashville TN

Assist in recruiting, hiring, training and developing a high performing staff consisting of Member Service Representatives, Trainers and Custodians. Assist in maintaining a welcoming atmosphere for all members, prospective members and guests and ensuring staff follows superior customer service guidelines. Provide backup support to Club Manager as needed. Assist in scheduling and supervising staff. Ensuring staff is always providing a superior customer experience. Assist in resolving or escalating member or employee issues and concerns. Involved in all front desk related activities including: Answer phones in a friendly manner to assist callers with a variety of questions Check members into the system, New member sign-up, Take prospective members on tours, Facilitate all member requests, from billing issues to general questions, Assist in overseeing cleanliness and maintenance of facility, Assist in ordering of supplies using specific budget based on club requirements, Assist in tracking statistics and reports (weekly, monthly, and annually)

Provider Relations Associate Analyst Cigna/Evernorth (Current Job)

September 2019 - Present 4 years Brentwood TN

Onboarding of new & existing providers into Cigna, checking applications, credentialing requirements, CAQH or OnePort/Medversant, sending contracts via docusign, networking providers once everything was received, determining networks for states/cities and whether to recruit or not, Outreaching to clinics and hospitals for missing or key elements of the recruitment & onboarding process. Helping with issues related to billing/enrollment by working with other Cigna departments to correct or re-enroll the provider. Worked with delegated & non-delegated providers across several states, conference calls biweekly determining new processes or state laws regarding credentialing/enrollment.

Provider Enrollment Rep Lifepoint Health

February 2019 - June 2019 4 months Brentwood TN

Complete Council for Affordable Quality Healthcare, Inc. (CAQH) credentialing process on new & established providers. Research payers for information on processes to enroll providers, Responsible for completing applications, re-credentialing applications, demographic updates and documents to each payer for processing. Follow-up with payers for effective dates, status updates, and identification numbers for provider payment and claims to be released. Input and/or maintain data for provider to include but not limited to, initial input of provider demographics, personal, medical documentation, effective dates, and comments. Maintain updated licenses, add locations and various groups. Monitor and maintain provider files to determine reason for pending enrollment and/or acknowledge all documents are received; request any documents and user names/passwords needed for enrollments; routinely update status changes. Perform routine administrative tasks to include but not limited to, processing applications, uploading and updated documents, notification forms, enroll provider(s) with all designated payers, and research process with payer in a timely manner. Communicate and provide updates to designated market contacts including CBO managers, Market managers and AVPs. Research payer enrollment questions and issues raised by market representative and /or providers and respond with resolution.

PAR (Patient Account Rep/Billing) Xtend Healthcare

June 2018 - January 2019 7 months Hendersonville TN

follow up on insurance claims (UB-04 and CMS1500), coding claims for reprocessing,

handling denials/rejections, identify trends with payers, submitting medical records when needed for

claims to process correctly, training and assisting new employees, knowledge of revenue cycle

Provider Enrollment/Credentialing Specialist Saint Thomas Medical Partners

January 2016 - May 2018 2 years 4 months Nashville TN

reviews enrollment applications, prepares verification letters and maintains database

for all Saint Thomas Medical Partners providers. Completes and maintains CAQH profiles for all assigned providers new and established. Submits credentialing and recredentialing applications for providers to be on hospital staff at Saint Thomas as well as other facilities. Maintains state licensing, DEAs for all providers so they stay in compliance with accreditation standards & legal requirements related to Medical Staff. Enrolls providers with all insurance payers as well as follow up on claims in regards to enrollment. Follows up in a timely manner on payer apps for effective dates, Provider IDs and enters the information into the billing system to release claims for provider. Enrolls provider in Medicare, Medicaid, BCBS, UHC, Cigna, Humana and several other commercial payers depending on contracts in the area. Works with managed care to review if a contract is needed in an area.

Billing Specialist Tennova/Gateway Medical Center

October 2015 - January 2016 3 months Clarksville TN

(position was being relocated to corporate office in Franklin TN)

Job Duties/Skills: prepare and transmits patient hospital claims (primary and secondary insurances),

corrects claims, working with coders and nurses to make sure all claim information is correct, resolves

unbilled claims and denied claims.

PAR (Patient Account Rep/Billing) Xtend Healthcare

October 2014 - June 2015 8 months Hendersonville TN

follow up on insurance claims (UB-04 and CMS1500), coding claims for reprocessing,

handling denials/rejections, identify trends with payers, submitting medical records when needed for

claims to process correctly, training and assisting new employees, knowledge of revenue cycle

Office Manager Pleasant View Eye Care

January 2011 - March 2013 2 years 2 months Pleasant View TN

filing medical & vision claims, coding, handling denials/rejections, credentialing with

insurance companies, checking in/out patients, referring patients to specialists, insurance verification,

ordering contacts & office supplies, helping patients with glasses, managing & training of employees,

general bookkeeping, accounting, closing each day and balancing financials.

Medical Office Coordinator HCA- Physician Services

June 2008 - May 2009 11 months Nashville TN

maintained physicians’ contract information (onboarding), authorized payroll for office

managers, assembled HR Packets for physicians, ordered supplies, updated Medline with current HCA

offices organized/attended dept meetings, prepared monthly budget packets, report to web reports, Super User in Healthstream where I maintained employee’s trainings and certifications, medical records requests for closed down practices, worked with enrollment dept. to assist with information needed for physicians to be credentialed with HCA, participated in conference calls, member of the EAG.

Front Office Manager TN Retina/Retina Associates

April 2006 - May 2008 2 years 1 month Nashville TN

Managing all administration employees including check-in/out, medical records,

Referrals, Patient Accounts/Billing, data entry, coding, insurance verification, handling employee reviews, raises, Working with foundations to help pay for pt treatments, training new employees, completing HR paperwork, creating spreadsheets on Excel for various reports as needed.

EDUCATION

Patient Care Technician Program Nashville State Community College

2023

Certificate of Completion- PCT Program

Nursing/Healthcare Mgmt Middle TN State University

2010-2008

Started Working on BSN, did not complete yet as family obligations came up

Pre-Nursing Arizona State University

2005-2004 Started working on pre-reqs for Nursing

Nurse Assistant Certification CNA School Nashville TN

2001 Completed CAN course & certification for Nurse Assistant

ACTIVITES

Zeta Tau Alpha Sorority Alumni

Girl Scouts of Middle TN Alumni

Volunteer with lots of organizations including Susan G Komen, American Cancer Society, Vanderbilt Health Clip in for the Cure, Hand on Nashville, & many more

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