Medical Billing Revenue Cycle

Veena Parkash

Chicago, IL ****************@*****.*** 773-***-**** LinkedIn: linkedin.com/in/veenaparkash

Professional Summary

Experienced Credentialing Specialist with a robust background in medical billing, credentialing, and revenue cycle management. Over 21 years of expertise in coordinating and maintaining credentialing processes for various medical professionals across multiple states. Skilled in managing full revenue cycles, ensuring compliance with NCQA, Joint Commission, and URAC guidelines, and utilizing CAQH for provider enrollment. Proven ability to enhance operational efficiency and ensure regulatory compliance.

Educations

Master of Science in Health Informatics (MSHI)

University of Illinois at Chicago, Chicago, IL (May 2024)

Bachelor of Science in Biology

Northeastern Illinois University, Chicago, IL (May 2013)

Associate in Biotechnology

Harry Truman College, Chicago, IL (September 2000)

Medical Billing Certification

AMS Medical Billing, Chicago, IL (February 2000)

SQL and Database Administration Courses

(2019-2021)

In Process- Data Analysis Certification

Computer Systems

●Office: Microsoft and Excel

●Medical: Echo, eClinicalWorks, Medisoft,

●Medical Manager, Intergy, Athena, Rislinq,

●Telcore, Modio, Central Reach, and Cactus

Core Competencies

●Credentialing & Re-credentialing Processes

●Medical Billing & Revenue Cycle Management

●Compliance with NCQA, URAC, and Joint Commission Guidelines

●CAQH Provider Enrollment

●Primary Source Verification

●Data Analysis & Reporting

●Strong Communication & Team Collaboration

Technical Skills

●Microsoft Office Suite (Excel, Word, PowerPoint)

●SQL, Python, Postgres, Tableau, and Minitab

●Medical Software: Echo, eClinicalWorks, Medisoft, Medical Manager, Intergy, Athena, Rislinq, Telcore, Modio, Central Reach, Cactus

Core Qualifications: Laboratory

●Lab Skills:

●SDS-page

●PCR/Cloning

●ELISA

●Electrophoresis

●Spectrophotometry

●Computer Data Analysis

●Amino acid analysis

●DNA/Extraction/Quantification

●Microscopy

Core Qualifications: Credentialing and Revenue Cycle

●Extensive experience in managing credentialing, as well as the re-credentialing process and accreditation

●Primary source verification for all specialties Physicians, DO, CRNA, CRNA, PA, Social workers, Midwife, and all Radiology physician, technicians and technologist.

●Extensive experience enrolling, credentialing and maintaining providers with CAQH

●Outstanding ability to work well independently or within a team

●Experienced in navigating Echo, including updating payor records within this system

●Extensive experience in maintaining all state and DEA licenses by retrieving information from primary sources on valid websites.

●Knowledgeable of credentialing guidelines, including NCQA, Joint Commission, URAC guidelines, as well as NPDB (National Practitioner Data Bank), OIG (Office of Inspector General), and SAM (System for Award Management)

●Familiar with Medicare/Medicaid guidelines, such as:

●Updating provider information using PECO and CAQH (Council for Affordable Quality Health Care)

●Experience in working with policies of Commercial, Medicare, Medicaid, Medicare and Medicaid-MCO, HMO, POS, and EPO

●Knowledgeable of IMPACT (Initial Interest, Mutual Selection, Pre-Service Training, Assessment, Continuing Development, Teamwork)

●Superior skills in managing and prioritizing multiple tasks and projects successfully.

●Extensive experience in managing full revenue cycle medical billing and collections.

●ERA/EFT and updating information online.

●Good written and oral communication skills

●Excellent and thorough trainer for new or existing employees with new systems or protocols

Professional Experience

Nephrology Associates of Northern Illinois and Indiana Chicago, IL 12/2024- Present

●Onboarding, credentialing and re-credentialing

●All commercial payor enrollment

●Manage and maintain accuracy of provider profiles with their active all licences

●Add and manage provider data manage with all payor’s directories

●Manage and Attest all states CAQH

●Request and update all group’s roster with payors

●Follow up all submitted credentialing and re-credentialing applications

●Maintain communication with providers, practice managers, and insurance representatives to ensure timely credentialing

WellSpan Health Group York, PA 05/2022- 12/2024

Credentialing Coordinator/ Enrollment Roster Coordinator

(Remote and contract base)

Responsibilities

●Process credentialing and re-credentialing.

●Maintaining all state and DEA licenses by retrieving information from primary sources on valid websites.

●Conduct primary source verification for all specialties, ensuring compliance with established policies.

●Maintain communication with providers, practice managers, and insurance representatives to ensure timely credentialing.

●Manage CAQH re-attestations and update provider credentials.

●Maintain all payor roster as assigned

Vengroff Williams Inc (Autism Home Support Rolled over) Chicago, IL 04/2020 – 03/2022

Credentialing Specialist (Remote)

Responsibilities

●Coordinate and maintain credentialing and re-credentialing for BCBA, BCaBA, and RBT across multiple states.

●Enroll providers in CAQH database and maintain their credentials.

●Verify certifications and establish productive relationships with medical providers.

●Collect and evaluate critical data to determine eligibility for credentialing.

●Resolve practitioner concerns and update credentialing software with current statuses.

Autism Home Support Services Northbrook, IL 09/2019 -04/2020

Credentialing Specialist

Responsibilities

●Oversee credentialing and re-credentialing processes for behavior analysts.

●Maintain provider credentials and verify certifications through BACB and ASHA.

●Collect and review data to ensure accurate credentialing decisions.

●Maintain logs and follow up to obtain verification of information.

●Resolve practitioner concerns and manage credentialing documentation.

Rush University Medical Center Chicago, IL 01/2018 to 09/2019

Credentialing Coordinator

Responsibilities

●Perform primary source verifications for licensure, board certification, and other credentials.

●maintaining all state and DEA licenses by retrieving information from primary sources on valid websites.

●Coordinate the credentialing and re-credentialing process for all specialties.

●Facilitate appointment and reappointment processes for medical staff.

●Update credentialing documents and maintain compliance with NCQA standards.

●Resolve issues requiring additional investigation and follow-up.

Swedish Covenant Medical Group Chicago, IL 12/2016 to 12/2017

Supervised Cardiology Revenue Cycle

Responsibilities

●Lead project teams to improve revenue cycle results and implement standard policies.

●Supervise a team of revenue cycle professionals, overseeing billing and follow-up.

●Monitor work queues and ensure resolution of claims issues.

●Collaborate with payment posting and reconciliation teams to address trends.

●Provide regular reporting on trends and issues affecting revenue cycles.

USA Vein Clinics: Northbrook, IL

Credentialing and Revenue Cycle Specialist Chicago, IL 04/2016 to 08/2016

Responsibilities

●Manage revenue cycle and coordinate credentialing for six clinics.

●Train and supervise new employees on revenue cycle processes.

●Resolve claim denials and establish patient payment plans.

●Research and expand knowledge on medical diagnoses and procedures.

Molecular Imaging Chicago: Chicago, IL

Medical Credentialing Manager Chicago, IL 11/2015 to 04/2016

Responsibilities

●Manage credentialing for 10 radiology clinics for all commercial payors

●maintaining all state and DEA licenses by retrieving information from primary sources on valid websites.

●Assisted manager to revalidation Medicare using PECO

●Assisted manager to revalidation/enroll individual provider for Medicaid using IMPACT(Illinois Medicaid Program Advanced Cloud Technology)

●Provide credentialing status reports to executives.

●Oversee revenue cycle management and ensure accurate billing.

Simple Laboratories: Chicago, IL

Revenue Cycle/Medical Claims/Credentialing Manager Chicago, IL 01/2015 to 11/2015

Responsibilities

●Maintaining all state and DEA licenses by retrieving information from primary sources on valid websites.

●Manage credentialing and revenue cycle for diagnostic laboratories.

●Ensure compliance with coding principles and manage collections for unpaid bills.

●Maintain regular reports on credentialing status.

MRI Lincoln Imaging Center: Chicago, IL

Credentialing Specialist/ Medical Revenue Cycle Specialist Chicago, IL 02/2002 to 01/2015

Responsibilities

●Coordinate diagnostic credentialing for six clinics.

●Manage revenue cycle responsibilities and train new employees.

●Verify patients' eligibility and manage claim denials and appeals.

●Maintaining all state and DEA licenses by retrieving information from primary sources on valid websites.

●Revalidate/enroll Illinois Medicaid providers using IMPACT

Illinois Department of Public Health: Chicago, IL

Laboratory Technician Chicago, IL 01/2001 to 07/2002

Responsibilities

●Prepare media for labs and maintain glassware.

●Log specimens and test for Syphilis and Rubella.

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