Credentialing Manager

Cheryl Gray

*** ****** ***** **** ***. *B, Bronx, New York, 10455 917-***-**** adij7h@r.postjobfree.com

Profile

Focused and motivated compliance and credentialing associate with experience verifying and maintaining the professional licenses and certifications of medical staff. Along with entry level experience with 340B compliance.

Experience

340B COMPLIANCE & CREDENTIALING ASSOCIATE BETANCES HEALTH CENTER MARCH 2020 – PRESENT

·Review and maintain all providers active with 340B pharmacies

·Process all credentialing applications for new and existing providers

·Keep up to date provider enrollment process and records and track provider participating levels

·Document and maintain provider applications, contracts, and updates into system

·Work with providers to collect required documentation for initial or recredentialing process

·Abide by all policies, procedures, and work instructions for the credentialing function of the Medicare plan

·Perform quality checks

·Review 340B prescription claims via 340Basics and CVS portals.

·Perform quarterly 340B activity audits

·Perform other duties assigned by supervisor

·Assist the billing department with claims and posting payments via eCW

RECRUITING SPECIALIST - CONTRACT EMPOWER HUMAN POTENTIAL NOVEMBER 2019 – PRESENT

·Sourcing and reaching out to qualified candidates

·Serving as a go between for candidates and hiring managers

·Recently promoted to handle the screening process from end-to-end prior to submission

·Utilizing MightyRecruiter and LinkedIn as one of my go sources for qualified candidates.

BILLING COORDINATOR CENTER FOR URBAN COMMUNITY SERVICES AUGUST 2016 – FEBRUARY 2020

·Responsible for reviewing and entering ACT claims using Cerner and AWARDs EHR’s

·Ensuring HCBS claims have been properly billed prior to submission

·Create 837I electronic batch claim files for upload

·Download x12/5010 payment files and manually post if needed

·Create and maintained eligibility spreadsheet once verification has been completed using eMedNY, Availity, Beacon and other web portals

·Create and maintained billing spreadsheets with applied formulas to track billing processes

·Ensure all HIPAA requirements and regulations are adhered to

·Run various Cerner and AWARDS reports to ensure progress notes, plans and forms have been locked daily

·Ensure all billing facilities were properly credentialed with insurance plans

·Maintain applications and supporting documentation

·Recredential facilities when necessary

·Document authorizations received by HCBS and ACT assistant program director

·Followed up on denied and rejected claims; research billing errors and submitted correct claims

·Manage e-Paces accounts

·Prioritize workflow when necessary

·Set up billing parameters in AWARDS

BILLING SPECIALIST – TEAM LEADER (SUPERVISOR TRAINEE) MANHATTAN MANAGEMENT SERVICES OF MT. SINAI ROOSEVELT/MT. SINAI ST. LUKE’S HOSPITAL SEPTEMBER 2011 – AUGUST 2016

·Influenced the charge entry department to increase charges entered on a monthly basis

·Ensured HIPAA requirements and regulations were adhered to

·Managed multiple projects during company’s downsized period

·Provided leadership to the charge entry department

·Responsible for training new hires on multiple EHR’s; such as e-Clinical Works, MD Everywhere, and IDX/TES systems

·Verified insurance eligibility using NaviNet, e-Paces, and other web portals

·Updated and/or added new and/or existing patient demographics

·Documented ICD, EP, Pacemaker, Tilt Test, Cardio Conversion, Bone Density, and Drug sheet reports to patient’s accounts

·Posted payments and rejections

·Reviewed hospital encounters housed on MD Everywhere and EPIC systems ensuring all encounters were accurately provided with the correct CPT and ICD-10 codes. Corrected the CPT and ICD-10 codes when necessary

·Coded medical progress notes using E/M codes and ICD-10 codes under CPC supervision.

·Charged multi-specialty encounters using IDX system

·Reviewed and worked TES (Transaction Editing System) edits

·Researched billing errors and re-billed accordingly

·Assisted with obtaining prior authorizations for outpatient services

·Oversaw all hospital clinic encounters, ensuring all were properly separated by division and distributed to charge entry team

·Responsible for all BI (Beth Israel) general medicine encounters

·Prioritized workflow when necessary

·Obtained and submitted medical records to insurance companies when requested for internal audits

·Utilized Eagle (Hospital EHR) systems to process eligibility and retrieve inpatient information

·Ensured all HIPAA requirements and regulations were adhered to

·Communicated with providers to ensure all progress notes were locked in a timely matter

·Worked in a collaborative matter with the Collections Department to resolve outstanding billing issues

·Completed monthly charge lag, unlocked and missing charges reports

MEDICAL BILLING INTERN (180 HR COMPLETED) MANHATTAN MANAGEMENT SERVICES OF ROOSEVELT/ ST. LUKE’S HOSPITAL AUGUST 2011 – AUGUST 2011

·Verified active insurance eligibility using IDX system

·Registered and updated patient financial accounts

·Coded missing diagnosis with current ICD-9 and ICD-10 codes

·Entered EKG encounters

Education

MEDICAL BILLING AND CODING CERTIFICATE SEPTEMBER 2011 SANFORD-BROWN INSTITUTE, NEW YORK, NEW YORK

ASSOCIATES IN COMPUTER PROGRAMMING & INFORMATION SYSTEMS JUNE 2003 ASA INSTITUTE, BROOKLYN, NEW YORK

Skills & Abilities

·

·Data Entry 10-key pad

·Proficient with IDX systems

·Proficient in Excel, Outlook and Word

·Intermediate experience in Accounts Receivables

·Excellent interpersonal and communication skills

·Poised under pressure

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