C

Dawn Clark

Workers Compensation Unit Stat Specialist and 226343

Yes

No

Availability for interview

Are you commutable to the office location?

Notice

* *****

List other opportunities the candidate is considering:

Reason

Candidate’s Overview

Performed Medical Insurance Reviews under the administration of the Vice President of Medical Staff Affairs.

Performed Credentialing in the Medical Staff Office.

Researched Credentials for Medical Students coming from various Countries, backgrounds, States, and entities with the desired goal of becoming Medical Physicians at UMDNJ, Performed extensive background checks.

Coordinated and set up various committee meetings. Performed Medical Documentation for the Worker's Compensation Division.

Provided Insurance verification.

Ensured that all documentation is reviewed according to the hospital's procedures and reporting guidelines.

Maintained and updated files for review.

Compiled records to include Worker's Compensation files.

Relevant Skills based on Position Requirements & Level of Experience

Requirement

Qualification

Worker's Compensation

8+ years

Dawn Clark

Laurel Springs, NJ 08021

MDS, Healthcare Systems, Mantua, NJ 08051 April 2012 - June 2023

Manager of the Credentialing Department.

Performed Initial Appointments and Reappointments of Providers Application Process.

Provided Credentialing with special attention to CAQH Credentialing and Provider Relations. Reviewed Provider Applications for Medical and Dental Staff to be submitted to various Medical Committees for granting of privileges.

Researched State Entities and Organizations for verification of receipt and status of Applications. Performed Background checks and verified immunizations, NPI, DEA, Medical Board Licenses and Malpractice Insurance.

Compiled records to include Worker's Compensation files.

Performed background checks on new providers for each location to include Educational Background checks.

Negotiated contract agreements.

Extensive contact with State entities for compliance status and State Contract Administration.

Worked closely with the Senior Management Team to meet State Standards, Medical Board, Compliance requirements and updates on issues pertaining to Credentialing.

Updated Credentialing Database routinely.

Healthcare Documentation Review.

University of Medicine & Dentistry of NJ (UMDNJ), 100 Central Avenue, East Orange, NJ April 2003 - April 2012

Medical Insurance Coordinator

Performed Medical Insurance Reviews under the administration of the Vice President of Medical Staff Affairs.

Performed Credentialing in the Medical Staff Office.

Researched Credentials for Medical Students coming from various Countries, backgrounds, States, and entities with the desired goal of becoming Medical Physicians at UMDNJ, Performed extensive background checks.

Coordinated and set up various committee meetings. Performed Medical Documentation for the Worker's Compensation Division.

Provided Insurance verification.

Ensured that all documentation is reviewed according to the hospital's procedures and reporting guidelines.

Maintained and updated files for review.

Compiled records to include Worker's Compensation files.

Transcribed Insurance interviews with clients thereby generating an internal report.

Worked closely with the Underwriting Department for Auditing and Claims Determinations.

Performed other duties as required.

Education: Associate in Cardiovascular Studies - Gannett Education - Arlington, VA

December 2010 to December 2011

Skills

Physician Credentialing & Contracts Specialist (10+ years)

Medical Education & Training (10+ years)

Worker's Compensation Review Specialist (8+ years)

CAQH Provider Management (10+ years)

Outcome Specialist (10+ years)

HEDIS (8 years)

Quality audits (8 years)

Evaluation of Data (8 years)

Contract Management (10+ years)

Time management

Data entry

Microsoft Office

Managed Care

Medical Coding

Medical Terminology

Medical Records

Transcription

Negotiation

Epic

Documentation review

Customer service

Proposal writing

Calendar management

Adobe Acrobat

Medical Education (8 years)

Recruiting

Accounting

Contracts

Mobile device.

Contact this candidate