Healthcare Administrative Professional
Resume:
Laura Felker, CPCS
Escondido, CA 92025
760-***-**** / *********@*********.***
Professional Summary
Seasoned healthcare office professional with more than 30 years’ experience. Established career working in hospitals, billing companies, medical groups, and private physician offices. Strong organizational and prioritization abilities with excellent computer, communication, and time management skills. Handles tasks with accuracy and efficiency. Areas of expertise include medical terminology, insurance billing/revenue cycle management, compliance, credentialing and contracting. Seeking position in a stable company with growth potential.
Skills
Microsoft Word/Excel/Teams/Outlook, Time management, Cerner, MD-Staff, Adobe suite, Computers and electronics, EZ-Cap, Echo/Healthstream, Quickbooks, Keyboarding >85 WPM, Medi-Soft, MSOW, Proficient English grammar/usage, Medical Manager, NueMD, Renaissance (LeonardoMd)
Experience
Credentialing Coordinator
Trinity Health Corporation - Livonia MI 08/27/2024-present
Responsible for work-up of assigned initial applications for providers. Prepare, track, and follow-up on all needed information for completion of file, ensuring timely and efficient processing while maintaining company credentialing standards and requirements.
Credentialing Specialist/Coordinator
Palomar Health/Palomar Medical Center Escondido - Escondido, CA 06/2016-06/27/2024
Responsible for all aspects of credentialing, re-credentialing, and privileging process for Medical Staff and Allied Health Professional Staff.
Prepare, track and follow-up on applications to ensure they are processed efficiently and in accordance with health system and Medical Staff Bylaws, and Rules & Regulations.
Prepare files for review, signature, and approval by appropriate departments prior to granting membership and privileges.
Possess working knowledge of Medical Staff principles and operations specific to regulatory expectations.
Maintain up-to-date provider data in credentialing database and on-line programs ensuring renewal of licenses and certifications.
Operate electronic mail system, company computer programs and various office equipment to maintain flow of information, internally and with outside entities.
Receive and route telephone calls and visitors to the department.
Support assigned committee by preparing agendas, attending meetings, recording minutes, and follow-up.
Other duties as assigned/requested.
Insurance Liaison
Comprehensive Autism Services and Education, Inc. - Carlsbad, CA 04/2012 to 10/2015
● Set up electronic insurance billing and payment processes.
● Negotiated and maintained insurance company contracts for agency and provider.
● Create, enter, and maintain client information into databases.
● Performed insurance verification, authorizations, electronic billing/claim submission using online resources.
● Contact insurance companies to check on status of claims payments and write appeal letters for denials.
● Receive payments and post amounts paid to customer accounts.
● Maintained and updated provider files for credentialing (CAQH) and insurance contracts.
● Maintained files for school district contracts and performed invoicing.
● Set up compliance program and shared HIPAA compliance officer duties with clinical operations manager.
● Locate and monitor overdue accounts, using computers and a variety of automated systems.
● Answer customer questions regarding problems with their accounts. Arrange for debt repayment or establish repayment schedules based on customers' financial situations.
● Record information about financial status of customers and status of collection efforts.
● Operate electronic mail systems and coordinate the flow of information, internally or with other organizations.
● Train and assist staff with computer usage.
Medical Transcriptionist
Kaiser Permanente, Zion Hospital – San Diego, CA 01/2011 to 05/2014
● Transcribe and return dictated pathology reports in electronic form for physician's review and signature.
● Prepare slide send outs, log in returned slides, arrange for courier service as needed.
● Receive and screen telephone calls and visitors.
● Perform a variety of clerical and office tasks such as filing and operating office equipment such as fax machines, copiers, and phone systems.
● Complete forms in accordance with company procedures.
● Operate electronic mail systems; learn to operate new office technologies as they are developed and implemented.
Billing Specialist/Financial Secretary
Alberto Chavira, M.D., A.M.C – San Marcos, CA 08/2003 to 08/2011
● Performed all aspects of electronic insurance and patient billing.
● Obtained insurance verification and authorizations, performed charge entry, claims submission, denials, appeals, and aging of accounts. Transcribe dictated reports for review and signature by providers.
● Set up HIPAA compliance program for company and trained employees.
● Maintained credentials (CAQH) and reappointment applications for providers including license renewals, permits, and memberships. Negotiate and maintain insurance contracts.
● Inventory and order office/clerical supplies. Perform primary maintenance on computers including backup of all files and databases.
● Open, read, route, and distribute incoming mail or other materials and answer routine letters.
● Perform payroll functions, such as maintaining timekeeping information and processing and submitting payroll.
● Collect and deposit money into accounts, disburse funds from cash accounts to pay bills and invoices, keep records of collections and disbursements, ensure account balances. Prepare and mail checks.
● Set up and manage paper or electronic filing systems, record information, update paperwork, maintain documents such as attendance records, correspondence, or other material. Record employee time off, enroll new employees in group health plan, communicate company policies/procedures to employees.
● Operate office equipment, such as computers, fax machines, copiers, and phone system and arrange for repairs when needed. Operate electronic mail systems and coordinate the flow of information, internally or with other organizations.
● Supervise other clerical staff and provide training and orientation to new staff.
Billing Manager
Paul Polishuk, M.D. - Escondido, CA 02/2001 to 06/2009
● Performed all aspects of electronic insurance and patient billing.
● Assisted physician with credentialing, compliance, and contracts.
● Receive payments and post amounts paid to customer accounts.
● Answer customer questions regarding problems with their accounts. Arrange for debt repayment or establish repayment schedules based on customers' financial situations.
● Contact insurance companies to check on status of claims payments and denials, write appeal letters for claims when necessary.
● Perform various administrative functions for assigned accounts, such as recording address changes and purging records.
● Use computers for various applications, such as database management and word processing.
● Conduct searches to find needed information and insurance verification using such sources as the Internet.
● Train and assist staff with computer usage.
Senior Account Manager 09/2001 to 08/2003
Physician Services Inc., - Escondido, CA
● Create, maintain, and enter client information into databases.
● Verify accuracy of billing data and revise any errors.
● Perform data entry, billing, and electronic submission of claims.
● Receive and post payments to client accounts.
● Answer calls from patient and assist with issues on their account.
● Operate office equipment, such as computers, fax machines, copiers, and phone system.
● Complete forms in accordance with company procedures.
● Complete insurance or other claim forms.
Affiliations
Member: NAMSS/CAMSS Lifetime member-Weight Watchers References available
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