Customer Service Credentialing Specialist

Stephanie D. Moore

**** ******** ****

Luttrell, TN 37779 865-***-**** **********@*****.***

OBJECTIVE

To utilize my prior experience in customer service, administration, billing/collections and medical credentialing to obtain a challenging, new position. I am looking for a position that demands excellent skills in both written and verbal communication, problem solving, decision making, and the ability to work independently in a fast-paced environment. EXPERIENCE

10/2024- Current Credentialing Specialist Halo Clinical Lab Job Responsibilities: Coordinates and assists in payer enrollment, re-enrollment, revalidation and submission of data/documents for providers and locations to participate in networks for reimbursement. Tracks, monitors and communicates with all payers regarding the status of provider enrollment or termination if necessary. Obtains initials and renewals of license in multi states for MD’s and NP’s, manages CAQH, maintains primary source verification, malpractice insurance, license, CME’s, credentialing data base in Modio and all required documentation under facility and state laws.

08/2023- Current Patient Care Specialist/Clinic Coordinator Fast Pace Urgent Care Job Responsibilities: Maintain behavior that is compliant with Federal and State regulations, guidelines, and requirements including working knowledge of all health information management issues such as HIPAA. Greet, register, instruct, discharge and provide general assistance to patients. Obtain and record demographic, insurance and financial information. Verify insurance eligibility and relay relevant information on payment policies and billing/collection processes. Collect co-pays, co-insurance, deductibles and past due balances. Retrieve and fax/mail medical records to primary care providers and insurance carriers per patient request. Answer telephone, take messages and return voicemails. Provide clerical support as required. Ability to adhere to the Core Values of the Company, of teamwork, communication, empowerment, quality of care, and friendliness. The ability to maintain friendly, cordial relations with all clients and employees; maintain a positive work atmosphere by acting and communicating in a manner that results in a positive work relationship with customers, co-workers and managers. Triage patients to rooms. Drug Screen certified. 03/2024- 10/2024 Credentialing Specialist CRH Anesthesia Job Responsibilities: Establish working relationships with internal and external personnel to facilitate all aspects of facility application processes as it relates to receiving privileges or approvals to work at a facility (ies) and maintaining the privileges, Coordination, receipt, and data entry of clinician information via standardized processes in the credentials software system(s) for the purpose of ensuring clinician information is accurate and up-to-date, Ensures current documentation is on file for all contracted clinicians and all pertinent documentation is forwarded to appropriate privileging and non-privileging facilities for initial privileges / approvals and re-appointments, Facilitates and tracks the entire facility application and reappointment process and documents accordingly, Initiates and ensures malpractice coverage for clinicians, Ensures facility requirements are met in order to present applications to facilities' Medical Staff Offices or Post-Acute places of service in accordance with quality standards. Prepares and ensures accuracy of clinician applications for Anesthesia providers. 11/2021- 03/2024 Credentialing Specialist II Aya HealthCare Job Responsibilities: While demonstrating a high level of customer service, I am responsible for assisting candidates during the Compliance process and ensuring they meet the requirements for the facility and Aya by the document due date. I set up labs, modules, forms that are required in DocuSign, validate Employment History, license verification, certification and ensure all information entered the system is correct. I do follow with expiring documents and make sure they are compliant. I maintain an on-time 94% and Aya’s benchmark is 84%. 06/2015-10/2021 Credentialing Specialist TeamHealth Job Responsibilities: Establish working relationships with internal and external personnel to facilitate all aspects of facility application processes as it relates to receiving privileges or approvals to work at a facility (ies) and maintaining the privileges, Coordination, receipt, and data entry of clinician information via standardized processes in the credentials software system(s) for the purpose of ensuring clinician information is accurate and up-to-date, Ensures current documentation is on file for all contracted clinicians and all pertinent documentation is forwarded to appropriate privileging and non-privileging facilities for initial privileges / approvals and re-appointments, Facilitates and tracks the entire facility application and reappointment process and documents accordingly, Initiates and ensures malpractice coverage for clinicians, Ensures facility requirements are met in order to present applications to facilities' Medical Staff Offices or Post-Acute places of service in accordance with quality standards. Prepares and ensures accuracy of clinician applications for hospital privileges / approvals, Maintains Credentials database(s) to identify and disseminate to others (onboarding, provider enrollment, recruiting, scheduling, contracting) hospital privilege / approval report status, Coordinates, completes, and follows-up on the reappointment process for hospitals, ensures appropriate APC and Supervisory paperwork is complete. Assisted in training new hire, state paperwork and application for facility requirements. I worked with TJC facilities, NPDB, CAQH, DEA, licensing boards and CVO’s.

01/2013-06/2015 Billing and Collections Ortho TN Physical Therapy Job Responsibilities: Responsible for billing charges, posting payments, running reports and balancing spreadsheets.

04/2008-12/2012 Billing and Clinic Manager Barker Sleep Institute Job Responsibilities: Fulfilled the role of Billing and Clinic Manager, with responsibility of supervising clinic, billing department, marketing to outside providers to bring in new business to the company, scheduling/ confirmation of appointments, collection of co-payments/balances on accounts, payroll, accounts receivable and accounts payable. I maintained the doctor’s privileges with insurance companies, license, certifications and malpractice. Education

10/2005 Nail Tech TN School of Beauty

03/2000 Tax Preparation H&R Block Tax School

08/1992-05/1994 Business management Pellissippi State 05/1992 Gibbs High School

Skills

• Medical Credentialing with Payers and Providers

• Medical Billing and Collection

• Scheduling

• Multi-line Phone Systems

• Office Administration

• Team Management

• Time Management

• Auditing

• Proficient in Microsoft Word, Excel, PowerPoint, 10 key

• Typing skills average 74-79 WPM

• Ability to multi-task

• Ability to meet deadlines and obtain goals

• Systems: Nextgen, Parallon, Verity, Exterity, Clockwise, Md-Staff, Q-Genda, Modio, Paycom, Kronos

• BLS certified

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