Credentialing Specialist

Lora Eddington

*** **** ******** **, ******** Springs, UT. 84045

*************@*******.*** PH: 801-***-****

Skills / Experience

• 20+ years in customer service

• 20+ years experience in the Health Care industry

• Excellent communication skills with a strong desire to meet goals

• 8 years in Emergency department

• 12 years in Eligibility Counseling/Patient Account Services department

• 2 years in Pharmacy Benefits with SelectHealth

• 5 years experience as Payer Credentialing Specialist

• Built and maintained positive working relationships with patients and coworkers

• Excellent skills diffusing stressful situations and dealing with unhappy patients and providers

• Knowledge of Patient Account Services processes

• Computer: Word Processing, Excel, Tandem, ISeries, Help2, Webcollect, Accretive, Facets, PHS, Sharepoint, Outlook, Teams, Sharepoint

• Experience in team-oriented situations requiring strong interpersonal and communication skills

• Worked closely with Physicians and staff to ensure things were in place prior to a procedure

• I have had excellent working relationships with the physicians offices I have worked with. Working together with their front office staff along with their nurses and PA’s have been a very positive experience

• Currently taking online courses with BYU-Idaho Pathways program seeking to obtain certifications in genealogical research

• Approximately 23 hours college; General Education/Real Estate course and looking into completing certifications for genealogy research

• Self -motivated

• Ability to multi task.

• Ability to prioritize and organize.

Work Experience :

Credentialing Specialist

Ventra Health (formerly Abeo), South Jordan, UT June 2017- Present

* Credentialing support for multiple medical practices, including payer credentialing and license/certification renewal. Interacting closely with client managers of practices in meeting credentialing needs. Direct interaction with providers for their individual issues as well as enrollment processes. Researching rejected claims to see if there was a credentialing issue. Working directly with payers, in multiple states, to make sure enrollment process was completed and accurate.

* Track progress of outstanding applications and report progress to client managers and team leaders.

* Assist in obtaining needed documentation from providers, such as state licenses, IRS documents, NPI notification forms, DEA numbers, Board Certifications, Malpractice Certification of Insurance, etc.

* Understand how provider credentialing impacts billing, contracts and EDI.

* Investigate solutions to problems and determine best course of action.

Pharmacy Benefits Specialist

Selecthealth Insurance, Murray, UT April 2015 – May 2017

Assist members, providers, and pharmacies in either getting a medication paid for or receive additional education in what needs to happen to get a medication paid for. In addition assisting members, providers, pharmacies as well as internal departments in understanding each member’s pharmacy benefits.

• Participated in team meetings to ask additional questions to resolve problematic situations

• Reached out to receive additional training with our Preauthorization team so that I could more fully assist our members as well as providers

Eligibility Counselor

American Fork Hospital, American Fork, UT July 1997 – March 2015

• Assist uninsured patients with potential funding sources. Includes Cobra, Medicaid, Auto, Workman’s Comp, Commercial Insurance, and assisting with the application process for the Affordable Health Care Act. If no other funding sources are available then assisting with application process for Financial Assistance through Intermountain Healthcare. Working closely with physician’s offices regarding uninsured patients. Using ICD9 codes or CPT codes to determine cost estimates. Communicating regularly with other hospital departments to ensure we have all billing items in place prior to procedure date. Working with community programs to assist patients with other options for healthcare needs. Contacting insurance companies to determine benefits. Working out payment plans with patients.

• Selected Contributions:

• Coordinated support for uninsured breast cancer patients. Luncheon for oncologists and surgeons to open a dialogue for additional services that might help breast cancer patients and their families participate in a retreat for healing.

• Assisted with American Fork Hospital’s “Girls Night Out” by providing a booth to answer questions regarding financial assistance, payment options, and other resources to assist patients in paying for their accounts.

• Department head for annual fund raising for United Way for 4 years. Included touring the United Way Warehouse, participating in service projects and collecting donation cards from Eligibility and Patient Account Services departments.

• Have received an “excellent contributor” rating since 2011 on annual employee evaluation

• Built mutually respectful relationships with third-party payers including Medicaid, workers compensation carriers, and independent commercial carriers.

• Developed strong working relationships with physicians office staff as well as the physicians themselves.

Billing Assistant

North Valley Emergency Room Physicians, American Fork, UT July 2006 – July 2014

* Reviewed dictations and records to make sure complete for billing. The billing company was out of state. They would send me lists of accounts that needed additional information. Reviewed records in order to obtain information or request additional dictation from physicians. Maximized reimbursement using this process. In 2006 American Fork Hospital did not have all records from the Emergency Department scanned into Help2. This required that I manually go through medical records and pull the charts in order to obtain the information needed to complete the billing process.

* Obtained knowledge of each required section for a complete dictation, i.e. History Of Present Illness, Physical Examination, Course of Action, etc.

• Rapidly mastered the excel program designed by PerSe Technology to log account information

• Built excellent working relationships with Emergency Room Physicians and Specialists

•

Emergency Room Registrar

Orem Community Hospital, Orem, UT July 1987 – June 1992

• Registered patients who came in to the Emergency Department. Called specialists as needed. Coded all emergency room charts at day end and submitted to medical records. Assisted in Administration by creating policies and procedures. Triaged patients and assisted staff in patient care as needed. Acted as operator. Completed registrations for other departments as needed. Completed registrations for all inpatients.

• Education

• Lehi High (Graduated 1981)

• Dixie College (1981 – 1982)

• UVU (Real Estate License 1994)

• Human Resources 12-week Course (2009)

• BYU Idaho Online (2014 - 2015)

*. BYU Idaho Online, starting again Spring 2023

References:

Suzanne Isom Manager Abeo/Ventra Health 801-***-****

Ashley Hunsaker Previous Manager Abeo / Ventra Health 801-***-****

Dr. Dean Shelton Emergency Room Physician / Group Leader 801-***-****

Robert Toone Director, Point of Service UVRMC 801-***-**** (Robert knew me as Lora Johnson)

Jodi Vickery Coworker at abeo 801-***-****

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