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Customer Service Credentialing Specialist

Location:
Englewood, OH
Posted:
May 19, 2023

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Resume:

TRACY L.

WHITE

adw7zb@r.postjobfree.com

937-***-****

Dayton, OH 45426

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SKILLS

Motivation

Task prioritization

Training

Problem-solving

Epic

Verbal communication

Organization

Teamwork

Quadax

CAQH

Cactus

Policies

Quality

Management

Microsoft Office Products

EDUCATION AND TRAINING

Indiana Wesleyan University

Dayton • 08/2013

Associate of Applied Science: Business Administration

SUMMARY

Hardworking and reliable with a background primarily in Healthcare Administration. Focused on going above and beyond to support a team and to serve customers. Trained in organization, time management, and customer service, highly motivated to learn and grow as a Credentialing Specialist or Healthcare Administrative Support.

Will bring outstanding interpersonal and communication skills, very detail-oriented, enthusiasm and commitment to strive for excellence would make a great asset to any team or organization.

EXPERIENCE

Premier Health - Credentialing Specialist

Dayton, OH • 10/2019 - 02/2023

Performed immediate and accurate credentialing processes for medical and allied health professionals, while complying with NCQA and Joint Commission guidelines. Execute primary source verification, such as background checks, training, and education. Obtain and examine applications to identify inaccurate information.

Performed proper documentation of correspondence from initial to reappointment processes by organizing 20 -50 credentialing files each month.

Premier Health - Patient Accounts Associate

Dayton, OH • 05/2008 - 10/2019

Devised effective payment plans, as well as managed accounts and refunds. Verified adherence to Medicare billing policies, procedures, and risk management by reviewing, billing, and assessing Medicare claims and edits. Acquired accurate reimbursement by promptly following up on Medicare claims for adjustments.

Enabled Medicare process improvement by developing and implementing new approaches for billing manuals.

Addressed and resolved billing issues for compliance and verified appropriate management of claims by partnering with Medicare/CGS. Managed over50 claims per day.

Dayton Heart Hospital - Supervisor

Dayton, OH • 08/1999 - 05/2008

Interviewed candidates and led recruiting and training of new hires.

Organized disciplinary actions reports by conducting yearly performance reviews.

Provided suggestions to streamline admission process, while performing audits on daily basis to ensure that admission process, while performing audits on daily basis to ensure that registration processed was completed with 100% accuracy.

Guaranteed adoption of standard operating procedures by collaborating with doctors, nurses, and office staff

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