Contact

ad3wye@r.postjobfree.com

www.linkedin.com/in/whitney-n-

purnell-mha-5a40225a (LinkedIn)

Top Skills

Project Management

Customer Service

Management

Whitney N Purnell MHA

Credentialing Manager

Atlanta, Georgia, United States

Summary

Experienced Operation Management Specialist with a demonstrated history of working in the hospital & health care industry. Skilled in Microsoft Word, Sales, Management, Training, and Microsoft PowerPoint. Strong administrative professional with a Masters of Law focused in Law in Compliance Concentration in Healthcare from Argosy University.

Experience

Georgia Spine & Orthopaedics

Credentialing, Benefits and 401k Manager

March 2023 - Present (10 months)

Atlanta Metropolitan Area

Lead the regional Americas People Experience Team, supporting processes related to the employee life cycle, providing a seamless service of quality and experience that exceeds colleague expectations across the region. Ensuring the team is adequately equipped to provide business advice on People Organizational (PO) transactional and policy-related topics. Work with broader People Organization leaders to evaluate team processes and procedures relating to the full employee lifecycle. Alignment team members as SMEs (Subject Matter Experts) across global Learning, Talent, DE&I, Rewards, Benefits, M&A (Mergers & Acquisitions), Payroll, and Talent Acquisition teams to deliver streamlined support and collaboration on Wiley initiatives and process changes. Set performance goals, conduct regular performance evaluations, and identify opportunities for training and development. Provide leadership, coaching, and development to drive engagement and performance.

Oversees adoption of standard operating procedures and service-level agreements to ensure accuracy, completeness and integrity of data and processes.

Oversee the delivery of HR services, including employee onboarding, benefits administration, policies and procedures, employee relations, and performance Page 1 of 8

management. Ensure compliance with relevant employment laws, regulations, and company policies.

Monitor KPIs (Key Performance Indicators) and SLAs (Service Level Agreements) to measure and improve the efficiency and effectiveness of People Experience Team.

Identify opportunities and common trends to streamline processes and implement best practices within the People Org function. Provider enrollment/Payor enrollment. Work closely with People Business Partners and other stakeholders to implement HR programs and initiatives, such as performance management, talent acquisition, employee development, and succession planning.

Wiley Edge

Compliance Specialist

July 2022 - June 2023 (1 year)

Synchronized Solutions

Credentialing Manager

October 2021 - April 2023 (1 year 7 months)

Atlanta, Georgia, United States

The essential functions include, but are not limited to the following: Build and maintain professional relationships with team members, as well as, with other departments, clients and payer representatives Maintain confidential client, provider, and Company information Collect crucial information from payer in terms of contract and credentialing requirements and process by payer/market/contract type Record all process, steps and results in contracts and credentialing software Manage all credentialing and re-credentialing functions with insurance payers Coordinate contract application to establish network status with all insurers Maintain various databases in support of the credentialing process Collaborate with other departments to ensure that payer contracts are administered accurately

Maintain knowledge and compliance of all federal and state regulatory and accrediting body standards

Oversee and manage payer agreements and all audit and reporting needs Correspond with and provide updates to insurance payers Coordinate provider enrollments in all commercial, state, and federal insurance programs

Keep accurate records of provider licensure/certification renewals Page 2 of 8

Ability and willingness to travel as determined by business need Perform job duties in accordance with the productivity and quality standards defined by Ipsum

Performing other duties as assigned

Insight Global

Compliance Specialist

July 2020 - April 2023 (2 years 10 months)

Atlanta, Georgia, United States

Coordinating and scheduling all activities and services/sessions provided by the center

Ensuring compliance with established company policies and procedures Managing the office within budget guidelines to include clerical and auxiliary supply purchases, equipment upgrades, and labor costs Increasing and stimulating new patient growth by supporting marketing and promotional programs

Maintaining accurate and up-to-date client records Achieving revenue goals by effectively managing patient scheduling, staff productivity, collections and receivable, and miscellaneous operations expenses

Acting as a liaison for clients to explain insurance benefits and communicating daily with payors concerning insurance benefits and authorizations Maintaining center and equipment cleanliness and safety and reports and/or corrects hazards when necessary

Monitoring employee time, attendance and reimbursement programs Verifying employee time sheets, monitoring approvals, processing edits and communicating with human resources concerning any pay discrepancies Providing impeccable customer service to clients, parents and center team Fusion Autism Center

Operations Manager

February 2020 - November 2021 (1 year 10 months)

Atlanta

Coordinating and scheduling all activities and services/sessions provided by the center

Ensuring compliance with established company policies and procedures Managing the office within budget guidelines to include clerical and auxiliary supply purchases, equipment upgrades, and labor costs Increasing and stimulating new patient growth by supporting marketing and promotional programs

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Maintaining accurate and up-to-date client records Achieving revenue goals by effectively managing patient scheduling, staff productivity, collections and receivable, and miscellaneous operations expenses

Acting as a liaison for clients to explain insurance benefits and communicating daily with payors concerning insurance benefits and authorizations Maintaining center and equipment cleanliness and safety and reports and/or corrects hazards when necessary

Monitoring employee time, attendance and reimbursement programs Verifying employee time sheets, monitoring approvals, processing edits and communicating with human resources concerning any pay discrepancies Providing impeccable customer service to clients, parents and center team Locum Connections

Credentialing & Licensing Manager

March 2019 - February 2020 (1 year)

• Consult with business development team and recruitment team. HR duties consist of payroll, background checks. Scheduling travel and benefits training to all personal. Assist with credentialing software. Create new hire and training software.

• Ensure that all personnel and services adhere to facility and staff policies, department guidelines, regulations, and government laws. Create Excel sheets and tables using all Microsoft systems and Power BI.

• Expertise in the following health plan functional areas: membership and enrollment, billing, claims and claim payables, products and benefits, provider services, provider networks, provider reimbursement methodologies, authorizations, utilization management, care management, customer service

• Responsible for physician contract development and maintenance, ensuring accuracy, quality, integrity, and compliance with policies and procedures. Blood Marrow Transplant of Georgia

Medical Records Coordinator PRN

November 2016 - February 2020 (3 years 4 months)

Atlanta ga

• As a Medical Records Coordinator I perform important functions at BMT. Responsible for managing patient records and medical logs. Required to keep in constant communication with healthcare professionals in order to ensure that the information they have is accurate and up to date. Also, currently trained in EMR data base.

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• Advanced knowledge of health care compliance policies, practices and systems. Contributes to the development of compliance principles, theories, and concepts. Maintained all medical records information both in paper files in the file room as well as on the electronic filing system.

• Collaborated with external agencies and partners to successfully fill open positions; partnered with HR Generalists at client companies utilizing innovative sourcing techniques (i.e. social networking, profiling and planning, internal and external relationship building and engaging passive job seekers) resulting in a 20% increase in manager satisfaction

• Screening potential physician candidates and conducting phone interviews. Evaluating physician credentials to determine if they meet the needs of the client. Assists employees regarding benefits claim issues and plan changes

• Ensure the accuracy all benefits enrollments in the HRIS to provide vendors with accurate eligibility information

• Processes and administers all leave-of-absence requests and disability paperwork: medical, personal, disability and FMLA. Effectively interprets FMLA and ADA implications as they relate to leaves of absences/disabilities. Responds to 401(k) inquiries from managers and employees relating to enrollments, plan changes and contribution amounts. Manages the annual catch-up contribution enrollment.

Kaiser Permanente

Operation Management Northside and Emory St Joseph Hospital January 2018 - March 2019 (1 year 3 months)

Greater Atlanta Area

• Project management expert in the Dept. Facilitate processes for the Organizational Self-Assessment Team to achieve consensus as needed

(e.g., how to divide up accreditation work, determine organizational priorities stemming from the results of the self-assessment, identify areas for quality improvement, etc.).

• Assist with new hire process and train new hired staff, schedule and facilitate regular meetings with the Organizational Self-Assessment Team, using good time management skills.

• Code and correct diagnosis codes based on ICD-10 and the physician management

Northside Hospital

Insurance Verification Specialist

January 2017 - January 2018 (1 year 1 month)

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• Communicated with doctors and specialists to obtain updated information on patients' cases and treatment plans.

• Collaborated with patients to create manageable payment plans based on insurance and financial need. Identified any discrepancies in insurance coverage and worked with providers to ensure that patients' needs are fully met.

• Coordinated patient data collation with various external referral sources. Assessed and adjusted insurance policy medication coverage as required. Contacted physician offices for procedure and medication authorizations as needed. Investigated and resolved queries and complaints pertaining to urgent orders.

• Advanced knowledge of health care compliance policies, practices and systems. Contributes to the development of compliance principles, theories, and concepts.

• Broad knowledge of health care industry practices and standards. Served on Medicare RAC team to increase the positive outcome of Revenue Global Administrative Solutions LLC

Medical Billing and Coding Specialist / Project Manager January 2013 - January 2017 (4 years 1 month)

Woodstock Ga

• Responsible for working closely with Case Management, Financial Counselors, and members of the Revenue Cycle Division with Blood Marrow Transplant at Northside Hospital.

• Responsible for insurance verification on a variety of patient types, which may include outpatient, inpatient or observation admissions. Reviews submitted claims information for payment. Ensures the accuracy and completeness of submitted claims. Escalates claims issues or concerns to senior team members and/or management. Using Microsoft, Adobe Creative Cloud Suite, Microsoft SharePoint and LMS administrator.

• Legal and factual research using both electronic and manual library searches. Review incoming disciplinary notifications from internal and external entities, exception to policy requests, re-establishment requests and complaints.

• Identify issues that require additional investigation, validate discrepancies and ensure appropriate follow up. Obtain required documentation for case consideration. Document all case related information and communications in established databases and software systems. Maintain responsibility Page 6 of 8

for the accuracy and integrity of the review and appeal data, outgoing correspondence, case review recommendations, and related applications.

• Administrator to these contracts, Commercial Bundle and Medicare Bundle Wellcare, Wellstar, Humana, Cigna, Optum, BlueCross BlueShield, Aetna and Coventry. Lead of corresponds with radiology department and auditor on patient claims and account in database.

Arrow Exterminators

Project Manager

April 2011 - December 2014 (3 years 9 months)

Brookhaven

• Responsible for scheduling termite inspections for our current clients and perspective clients. Managed and entered all data into company database and randomly monitored and checked information for accuracy to ensure quality, client satisfaction and to avoid unnecessary cost.

• Managing the records and file when technicians bring their work in. Worked backup for busy phone system to answer pest control, termite and mosquito service and payments. Coordinated the deposit and accounts receivable and customers’ accounts

• Maintained excellent report system for the termite renewal area in the company. Out of eight regions we are first to developed efficiency enhancing procedures that improve our termite area.

• Created and headed the interview process for the Data Information Specialist position along with writing the employee description and performance expectation. Processed and submitted quarterly statements and annual reports with in Pest Pac database. Adobe Creative Cloud Suite. Interview applicants about their experience, education and skills. Contact references and perform background checks

• Responsible for providing administrative and clerical support for department managers and/ or staff. May take and deliver messages, provide information to callers, set up and maintain files, provide employees with office supplies, prepare and sort mail, perform word-processing assignments, proofread, and research and compile special reports. May operate automated office equipment and utilize software. Assists in the preparation of reports, graphs, and presentations using spreadsheet, graphic software, and/ or database applications. Inform applicants about job details such as benefits and conditions. Hire or refer qualified candidates

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Education

Capella University

Masters of Healthcare Administration, Healthcare Operations · (June 2020 - December 2021)

Saint Leo University

Bachelor of Applied Science (B.A.Sc.), Health/Health Care Administration/ Management · (2016 - 2017)

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