Medical Billing Data Entry
Resume:
Victoria Phillips
St. Louis, MO *****
adt8eb@r.postjobfree.com
A dedicated professional with a considerable amount of experience in healthcare claims and customer service. Excellent written and verbal communication skills, along with excellent interpersonal skills whose mission is to perform the needs of
Work Experience
Credentialing Coordinator
Heartland Dental, LLC - Creve Coeur, MO
March 2022 to Present
• Complete insurance applications and contracts for over 1500 supported dentists
• Verify professional licensures to meet the requirements of our delegated insurance contracts
• Communicate with insurance administrators to maintain up to date files on supported dentists
• Ensure accuracy of files by tracking the expiration of licenses and certifications
• Maintain up-to-date knowledge and understanding different insurance plans and Medicaid
• Assist supported offices and administration with Explanation of Benefits, Claims, and other insurance related issues
• Support special projects for the Dental Insurance Administration team, reports, and other such projects to support the work of the Dental Insurance Administration Department Provider Liaison
Preferred Family Healthcare, Inc. - Saint Charles, MO October 2021 to February 2022
· Coordinates receipt of credentialing request forms; performs review and analysis, to identify any missing or incomplete information and performs follow-up to obtain missing information.
· Responsible for verifying information provided by new hires and notifying HR when completed.
· Responsible for maintaining contact with programs and sites and keeping applicable information updated in enrollment software.
· Responsible for ensuring accuracy of data in enrollment software and contracting database.
· Completes data entry of provider information in enrollment software and CAQH and notifies enrollment specialist when completed.
· Assists providers with renewals of licensures and registrations and any related inquiries. Project Manager II
Centene Corporation - Chesterfield, MO
October 2019 to October 2020
· Manage the full project life cycle including requirements gathering, creation of project plans and schedules, obtaining and managing resources, managing budget, and facilitating project execution, deployment, and closure.
· Utilize corporate and industry standard project management tools and techniques to effectively manage projects.
· Assist with establishment and maintenance of corporate project management methodology and other department procedures.
· Maintain detailed project documentation including meeting minutes, action items, issues list, and risk management plans.
· Effectively communicate project status to all stakeholders.
· Negotiate with project stakeholders to identify resources, resolve issues, and mitigate risks.
· Coordinate cross-functional meetings with various functional areas to meet overall stakeholder expectations and company's objectives.
· Provide functional and technical knowledge across multiple business and technical areas.
· Monitor the creation of all project deliverables to ensure adherence to quality standards including design documents, test plans, training materials, and operations documentation.
· Create and communicate project milestone documents, dashboards, ROI tables, and departmental success metrics.
Business Analyst I
centene corp - Chesterfield, MO
October 2018 to October 2019
· Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of new systems
· Identify and analyze user requirements, procedures, and problems to improve existing processes
· Perform detailed analysis on assigned projects, recommend potential business solutions, and assist with implementation
· Identify ways to enhance performance management and operational reports related to new business implementation processes
· Develop and incorporate organizational best practices into business applications
· Lead problem solving and coordination efforts between various business units
· Assist with formulating and updating departmental policies and procedures
· Identify opportunities for process improvement and work with various stakeholders to drive improved business performance
Senior Coding Analyst
Centene corp - Chesterfield, MO
August 2015 to October 2018
· Triage all incoming inquiries, cases, projects, & emails from state health plans and the claims department using coding & state-specific expertise.
· Provide research necessary to address issues & concerns that potentially prevent provider abrasion. * Assist in training & auditing analysts on various systems, coding principles, & state- specific guidelines using subject matter expertise of departmental protocols & state health plan guidelines.
· Maintain departmental knowledge resources for state health plans.
· Allocate and oversee HCI (Health Care Insight) & CXT (ClaimsXten) daily workload of analyst for state health plans assigned, which includes code editing reviews, adjustments and appeals. * Prepare and analyze weekly & monthly department reports for state health plans to aid in identification of coding trends, cost savings, impact of adjustments/appeals to savings, and provider usage. Coding Specialist
Centene corp - Chesterfield, MO
August 2015 to August 2015
· Accept/reject clinical coding recommendations based on provider documentation, administrative policies, regulatory codes, legislative directives, or other guidelines to perform analysis of provider billing against Current Procedural
Terminology (CPT) coding logic and rules.
· Finalize reimbursements based upon audit findings.
· Assist with research of health plan coding questions.
· Maintain appropriate records, files, and documentation to comply with the company's Policy. Sr. Customer Relation Representative
Essence Healthcare - Maryland Heights, MO
February 2010 to October 2014
· Answer provider and member inquiries, benefits / eligibility, billing questions and provide guidance on claim transactions.
· Review and discuss the processing of healthcare claims that are paid or denied.
· Discuss inquires in which includes benefits and eligibility information, billing and payments, customer material request, and physician assignments
· Interacts with other departments for prior authorizations for treatment, quality issues, network administration and compliance.
· Review contracts and discuss credentialing issues. * Discuss appeals, grievances, and pharmacy issues.
· Abide by Medicare's Guidelines.
· Managed a high-volume workload within a deadline-driven environment.
· Point person for new representatives and particularly challenging calls as one of the company’s primary mentors/trainers of both new and established employees. Education
FOREST PARK COMMUNITY COLLEGE
January 2021 to Present
GED
UNIVERSITY CITY AEL
April 2013
Skills
• Microsoft Access
• Project management
• Microsoft Excel
• Project management methodology
• Project management software
• Business requirements
• Requirements Gathering
• Business Analysis
• User Acceptance Testing
• Scrum
• Agile
• SQL
• Jira
• Process Improvement
• Microsoft SQL Server
• Data management
Assessments
Scheduling — Proficient
November 2021
Cross-referencing agendas and itineraries to avoid scheduling conflicts Full results: Proficient
Supervisory skills: Interpersonal skills — Proficient December 2020
Fostering a collaborative environment and conducting difficult conversations Full results: Proficient
Medical billing — Proficient
December 2021
Understanding the procedures and forms used for medical billing Full results: Proficient
Protecting patient privacy — Proficient
November 2021
Understanding privacy rules and regulations associated with patient records Full results: Proficient
Attention to detail — Proficient
November 2021
Identifying differences in materials, following instructions, and detecting details among distracting information
Full results: Proficient
Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field.
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