LINDA K THIELE

**** ******** ** #**** • Fullerton, CA 92833 • 714-***-**** • ad3zqs@r.postjobfree.com

CAREER OBJECTIVE

A professional individual is seeking an opportunity within a Health care facility where I can utilize my knowledge and abilities, as well as make a positive contribution to the medical community.

SKILLS & QUALIFICATIONS

•CPT, & ICD-10 Coding

•Worker's Compensation

•Medical Billing

•HMO / PPO

•CMS 1500 Claims Forms

•Medi-Care

•Collections / EOB’s

•Medical Terminology

•QuickBooks (basic)

•Data Entry / Type 30 wpm

•Microsoft Office

•Eyefinity

•Xifin (Billing Software)

•Cactus

•CAQH

•CVOne = Aperture

•Excel

•OfficeMate

•eVips (Credentialing Software)

•PIMS

•ADOBE PRO

•Microsoft Teams

•Macess

•Word

WORK EXPERIENCE

Judge Group (Optum/NLH/Temp/Remote) Brewer, ME

Sr. Credentialing/Medical Data Entry February 2024 – February 2024

Duties:

Provided insight on a corrective action plan for departmental workflow in reference to the NLH.

Reduce backlog for the team.

Check the CPDM email daily.

Enter Providers updated info on Echo system.

Demonstrate and maintain credentialing knowledge.

Assisted staff in maintaining an 80% accuracy rate.

Provided outreach to request any missing or expired documentation from the provider’s offices for pending files.

Guardian Promotions Fullerton, CA

Customer Service January 2023 – December 2023

Duties:

Respond to quote request/product information request.

Prepare product estimate for sales dept.

Communicate with clients on order status.

Provide customer support and problem resolution if necessary.

Process sample orders.

Judge Group (Optum/TCHP/Temp/Remote) Houston, TX

Credentialing Auditor April 2022 - October 2022

Duties:

Provided insight on a corrective action plan for departmental workflow in reference to the TCHP matrix guide. Part of the OAS team under the credentialing department was responsible for auditing credentialing packets in verifying all the necessary documents and data elements aligned for accuracy along with providing insight to leadership on filling the gaps from previous experiences, current policies, and workflow.

Performed credentialing and re-credentialing file and system data entry audit activities according to TCHP Credentialing Policies and contracted health plan policies.

Demonstrate and maintain credentialing knowledge.

Reviewed errors with a credentialing specialist on missing items within provider packets

Assist in staff maintaining an 80% accuracy rate.

Provided outreach to request any missing or expired documentation from the provider’s offices for pending files.

Complete and closed credentialing packets.

SpectreForce Agency (Blue Shield of California/Temp/Remote) Monterey Park, CA

Administrative Compliance Associate April 2021 - April 2022

Duties:

Provide ongoing support to the team and ensure weekly goals are met.

Request documentation from providers’ offices for pending files

Verify and update provider information in Cactus

Complete and closed credentialing files for the Behavioral Health Project & BSC recredentialing project Successfully.

Update tracking logs for each project assigned to.

Verify licenses, on various websites

Help to create a Desktop procedure for new vendors

Pull providers documents from CAQH

Ensured team members completed their binders and checklist and Cactus entries are correct for the Behavioral Health Project, BSC recredentialing project.

Prepare issue files for committee review

Work with Team members and internal departments on inconsistencies in findings.

MediQuest Staffing (Pathnostics/Remote) Irvine, CA

Medical Data Entry September 2020 - November 2020

Duties:

Data Entry of Patients Demographics, Insurance and Coding

Fixing any errors in Xifin (software) found and updated with correct information.

Reviewing Requisitions, Lab Documents, and Insurance info for updated information and sending back for review of outdated information.

MediQuest Staffing (Prospect Medical/Remote) Orange, CA

Credentialing Coordinator July 2020 – August 2020

Duties:

Data Entry of Provider Information such as NPI and Licensing Information

Review provider credentialing and re-credentialing applications for completeness

Maintain 80% accuracy rate on the number of files submitted for the credentialing committee(s)

Retrieve Provider Data from one system and enter and update information into another system.

Allred Family Eye Care Fullerton, CA

Insurance Biller October 2014 – May 2019

Duties:

Submits insurance claims electronically or via paper CMS-1500 form

Follows up with insurance company on unpaid or rejected claims

Resolves issue and re-submits claims.

Credentialed Doctors: 6 Doctors (Medi-Care, HMO, PPO & Vision Insurances)

Audit claims

Front Desk duties: intaking patients and scheduling appointments

Verify patient benefits eligibility and coverage

Posts insurance and patient payments

HIPPA compliance by implementing guidelines from risk assessments

Prepares patient statements for charges not covered by insurance. Insured statements are mailed on a regular basis.

Collections of patients past-due accounts

For patients with coverage by more than one insurer, prepares and submits secondary claims upon processing by primary insurer

Creates patient aging reports

Data entry for patient demographic

Knowledgeable of ICD 10 diagnosis and CPT treatment codes

Answers patient questions on patient responsible portions, copays, deductibles, write-off’s

Resolves patient complaints or explains why certain services are not covered.

Medicare Billing

Ultimate Chiropractic Anaheim, CA

Front Office/Medical Billing August 2014 - October 2014

Duties:

File patient charts/medical records

Front Desk duties answer phones, scheduling appointments and patient processing.

Medical Billing/CMS-1500

Workers Compensation, PI, PPO

La Habra City School District. La Habra, CA

Noon Duty Supervisor August 2011- December 2013

Duties:

•Supervises students at play and during eating time.

•Maintains a harmonious atmosphere in eating area.

•Helps to guide pupils in developing good habits of sportsmanship.

•Encourages and promotes courtesy among children.

•Observes that safety rules are obeyed and applies school site discipline policy and student conduct code.

•Assists students in resolving minor conflicts on the playground.

•Reports unauthorized activities and unauthorized persons on school grounds to appropriate authority.

•Assists with the preparation and signing of accident reports if children are injured.

•Performs related tasks as required.

AllBizPromos.com La Habra, CA

Sales/Customer Service February 2000 – May 2009

Sales Duties:

•Respond to quote request/product information request

•Prepare product estimate and confer with potential client

•Send out written quote/answer client questions

•Collect customer payment

•Communicate with client on order status

•Provide customer support and problem resolution if necessary

Office Duties:

•Organize office files

•Calculate sales rep commissions

•Order product catalogs from various vendors

•Process sample orders

•Purchase office supplies

EDUCATION

American Career College Anaheim, CA

Medical Biller & Coding Program September 22, 2014

GED

VOLUNTEER WORK

PTA President & Vice President June 2010 – July 2011

•Organize: plan and set priorities

•Recruit, manage, motivate, and retain volunteers.

•Welcome a diverse and inclusive group of members, volunteers, and leaders.

•Run effective programs

•Manage money and raise funds

•Support membership growth and retention

•Run effective meetings

•Ensure all voices are heard through the effective use of parliamentary procedure.

•Advocate on behalf of students.

•Transition to the next leadership team by nurturing potential leaders and preparing the incoming team

•Performing specific duties as provided for in the bylaws

Contact this candidate