Maryann Lukay

*** ********* *****, **********, ** 33324

Cellular Phone:813-***-****

Email: ad49co@r.postjobfree.com

PROFESSIONAL SUMMARY

Professional seeking career in healthcare insurance industry, with a focus on, credentialing, provider enrollment, customer service and medical claims billing expertise.

WORK EXPERIENCE

NuView Health September 2023 to March 2024

Credentialing Specialist (Temporary position)

Completed Onboarding, collected credentialing documents, primary source verifications of new providers joining the practice.

Prefilled and follow up on hospital applications to facility Medical Staff for Telemedicine privileges approval for strict deadlines in 14 states.

Processed provider Medical Licensure through IMLC, DEA, CSR.

Managed Initial and re-credentialing physician applications.

Requested related COI insurance claims history reports and case logs for physician credentialing files.

Managed re-credentialing of existing providers.

Assisted Manager with special projects as needed.

Hayes Locums LLC January 2022 – August 2023

Credentialing Coordinator

Prefilled online or paper credentialing applications for physicians and mid-level providers.

Communicated with provider via email and telephone regarding application requirements, missing data.

Collaborated with team members to expedite urgent applications using Adobe E-sign.

Used Salesforce and MD Staff to compile vital information regarding providers credentials to add to provider’s application.

Mailed credentialing applications to providers.

TeamHealth August 2016 to December 2021 Provider Enrollment Coordinator

Enroll credentialed INPHNET emergency medicine physicians & midlevel for Southeast regional accounts.

Handle Medicare, Medicaid, BlueCross provider revalidations processing and sending paperwork to providers timely.

Prepare and process carrier applications necessary for issuance of provider number through PECOS Medicare and FL Medicaid associated with the billing claims.

Handle created stationery for issue of IDX number.

Maintain deletions, additions, and changes to the maintenance file pertaining to physicians and to gather pertinent information including periodic review of revalidations.

Handle special projects Facility start up’s large volume enrollment of physicians with specific requirements and deadlines for assigned areas.

Work independently through telephone communication and written correspondence with provider and fiscal intermediaries to facilitate the provider enrollment process.

Corvel Corporation November 2015 to May 2016

Bill Review Analyst

Reviewed client billing claims for accuracy and correct CPT4 ICD 9 & ICD10 coding. Data entry of missing claim information as needed.

Implemented client bill processing procedures daily with high performance quality metrics.

Worked with the adjuster via email to expedite claims billing errors and incorrect member identification data.

Handled other clerical duties as needed for the department manager.

Intermedix May 2015 to November 2015

Accounts Receivable/Collections Specialist- Temporary position

Conducted patient medical eligibility verifications using Zirmed system for emergency service claims.

Handle insurance inbound calls regarding missing patient data.

Handle complex probate and bankruptcy claims appeals recoupment with strict deadlines.

Inbound calls from patients in multiple geographic Florida counties regarding EMS billing inquires.

Process accounts receivable from the customer and insurance payments daily.

Assist operations manager with special projects as needed.

Coventry Healthcare Oct 2010 – April 2015

Integrated Service Specialist

Research physician and ancillary provider disputes on workers compensation and auto claim payments.

Validate contract effective dates, term dates and fee schedules to determine if claims were paid according to the client’s contract. Providers may have multiple fee schedules for each Coventry Health Care client.

Validate the provider’s national rate code (NRC) per the contract type (WC / Auto). Validate claims adjudication is correct by ensuring contract is active for the date of service. Validate pricing by procedure code is correct to determine if the percentage of billed charges is correct per the client’s contract with Coventry Health Care.

Educate providers as needed on correct billing procedures, or contract terms.

Interface with Coventry worker’s compensation clients to resolve inquiry and concerns, including those of a difficult and challenging nature. Take responsibility for following through and bringing outstanding issues to closure. Investigate, analyze and resolve outstanding issues to achieve client satisfaction.

Handle complex litigation claims working with attorneys and providers to expedite required documentation, contract verifications.

WellCare Inc., Tampa, FL Dec 2007- Oct 2010

Claims Specialist

National claims processor for Medicare and Medicaid professional claims.

Supported Provider Relations on special claims project to reprocess claims to ensure provider satisfaction with the plan and to maintain the relationship with the provider.

Responsible for processing claims that involved coordination of benefits.

Loaded contracts to allow claims to adjudicate correctly.

Chosen for an “elite” three-member team to work on special high priority projects.

EDUCATION

Fordham University, New York, Bachelor’s Business Administration, Marketing/ Management

SKILLS

Salesforce, MD Staff, Modio, Adobe, Microsoft Office365 Outlook, Word, Excel, Advanced medical terminology, excellent multi-tasking and telephone negotiation communication skills, results-oriented

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