C A Billing Specialist
Resume:
Bachelor of Science
Advanced Honors Diploma
Hampton, VA
Completion: June 2002
Norfolk, VA
Completion: May 2007
Major: Mass Communication/
Broadcasting
***************@*****.***
2016 Seldendale Dr., APT D, Hampton. VA,
23669
Sentara Healthcare 01/2020-03/2023
S K I L L S
C O N T A C T
E D U C A T I O N
O B J E C T I V E
W O R K E X P E R I E N C E
Phoebus High-school
Norfolk State University
Provider Credentialing Analyst
Experienced Credentialing Specialist and Billing Specialist adept at conducting application reviews and primary resource verifications among multiple medical systems. Excellent relationship-building, problem solving, and communication skills. Highly organized and detail oriented with in- depth knowledge of insurance regulations and Provider Credentialing. Works productively with groups, individual professionals, and facilitie. Enters, updates and maintains data from provider applications into credentialing database ensuring PHI and PPI are followed. Maintaining contact with healthcare professionals and guiding them through the required compliance documentation for assignments.
Outreach to various medical specialty boards, educational institutions or medical facilities to inquire about practitioner credentials, work history, or other findings related to determining credential qualifications, also shares essential updates with providers and the internal team as necessary in weekly summary reports.
Ensures practice information is current with health plans, agencies and other entities.
C R Y S T A L W I L K I N S
P R O V I D E R C E R T I F I C A T I O N /
M E D I C A L B I L L I N G
Enrollment/Billing Analyst
Cigna Healthcare 04/2023- 08/2023
Reviewing client's payment history to determine if they have made the correct payments. If no, the analyst will outreach for payment.
Audits accounts and enrollment/billing processes to identify improper charges, validate transactions, and ensure accurate and timely payment of amounts due.
Identify and recover debts due to the organization and refer delinquent accounts to external collection agencies. Creates initial reports/analyses for review and manages specific Enrollment/Billing processes and programs. Completes calculations based upon data to determine if a client has paid appropriately or is currently in arrears. Provider Enrollment/Credentialing
Enrollment Coordinator
CVS Healthcare
09/2023- 05/2024
Processing enrollment of Medicare members including first- time enrollment and member modifications.
Manage work activities in your work queue (i.e. enrollment missing information, enrollment with effective date change). Interface with other system applications for research and, where applicable, updating them with actions/outcomes of enrollment activity.
Complete outbound enrollment verification member calls. Update Excel spreadsheets to track workflow of various special assigned projects.
Answer incoming agent/broker calls regarding special needs
(low income) enrollment plans.
Medicare/Medicaid
CAQH, CMS/PECOS, CVO, NCQA
HIPPA, PHI, PFI
E X P E R T I S E
W O R K E X P E R I E N C E
License/Billing Verification
Provider/Group Enrollment
SHS
AR Aging
Medicare/Medicaid Billing
Claims Examiner
Web/Paper Applications
CMS/MMIS
Microsoft Office/ Excel
Provider Specialties
Inpatient/Outpatient
Medical Terminology
Provider/Group Enrollment
Verification of enrollment forms and other requests related to student status.
Assist with the preparation of the Scheduling Guide, registration of students, graduation process and other duties as assigned by the Registrar.
Process all student status information. Other duties as assigned by Registrar office.
Process all student status information.
Assist with registration and graduation.
Verification Clerk
Norfolk State University
12/2002-02/2007
Process medical facility claims payment according to account- specific contract (HMO, PPO, EPO, etc)
Verify that all ICD-9, CPT, modifiers and revenue codes are used correctly, prior to payment approval.
Experience with Medicare, Medicaid and commercial insurance coordination of benefits.
Investigate Medicare, Medicaid and individual insurance payments in order to release benefits.
Works all claims and billing duties.
Tidewater Physicians Medical Group
Medical Claims Examiner
01/2008-12/2013
Reviews and screens initial and revalidation credentialing applications for completeness, accuracy, and compliance with Medicare and Medicaid.
Conducts primary source verification, collects and validates documents to ensure accuracy of all credentialing elements Performed licensing verifications including NPPES, DEA, and SAM.
Research the providers MCS to make sure they are certified. Enters, updates and maintains data from provider applications into credentialing database.
Wisconsin Physician Services 02/2014-12/2019
Provider Credentialing Specialist
Contact this candidate