Human Resources Generalist

Kelli Griffin

405-***-**** *****@***.*** Noble, OK 73069

SUMMARY

Strong knowledge of provider credentialing, human resources, and licensure verification. Communicative and team-oriented with proficiency in Microsoft word, and navigating CAQH. Knowledge of Human Resources generalist for a healthcare system. Proven history of fostering leadership to meet team, individual and management objectives.

SKILLS

Training and development

Application file verification

Knowledgeable EMR, CAQH, and insurance websites

License verifications

Human Resources payroll systems

Insurance procedures

Solo practitioner credentialing

Policies implementation

Personnel recruitment

Knowledgeable in HRP

Answering benefit inquiries

Performance Evaluations

Compensation for Human Resources

EXPERIENCE

Human Resource Specialist, Norman Regional Health System January 2022-Current

Norman, Ok

Employee vouchers to process job changes and rate changes

Licensure

Exit interviews

Help employees with concerns

Tuition reimbursement

Helped with employee transfers and referrals.

Performance Evaluations

Compensation in Human Resources

Onboarding new employees

Referral, Credentialing Coordinator, Premiere Pediatrics, November 2000-2021

Norman, OK

Tracked referral request progress and resolved issues to maintain smooth processing.

Assisted patients by answering questions and providing information regarding referrals.

Managed and obtained insurance authorizations for patient referrals from physicians.

Kept close tabs on documentation expiration dates, communicating with correct personnel to submit files prior to expiration.

Aided clinical team to support administrative needs for clinical referrals.

Coordinated referral orders for patients of provider.

Gathered and verified insurance requirements to meet payer requirements.

Collaborated with physicians to ensure timely completion of hospital applications.

Obtained PA for services such as diagnostic imaging.

Liaised with healthcare facility personnel, insurance representatives, physicians and vendors for smooth communication.

Communicated with insurance representatives to gather information and verify patient benefits to determine clearance for specialty provider services.

Utilized well-developed active listening, interpersonal and communication skills in collaborating with diverse individuals each day.

Collected required signatures to initiate referral process.

Offered high level of assistance during managed care auditing process and conducted internal file audits.

Maintained informational resources, tracking and documenting requests for updates, certification and credentialing.

Performed primary source verifications such as criminal histories, licenses and board certifications.

Addressed credentialing requests, overseeing compliance with governmental and organizational guidelines regarding tiered data access.

Confirmed facility and user credentials to initiate and maintain registration and enrollment processes.

Completed enrollments into Medicaid, Medicare and private insurance plans.

Processed documents and status-change requests, conducting follow-up assessment regarding enrollment inquiries.

Set up NPI numbers for providers and facilities and updated current profile information.

Performed database queries, compiling information according to requests and logging logistics changes.

Organized records to prepare for site visits by insurance representatives and associated audits.

Billing Manager, Premiere Pediatrics, December 2000-November 2017

Norman, OK

Resolved billing issues by applying knowledge and completing in-depth research.

Developed improved standard operating procedures to increase billing accuracy and cash flow.

Conducted insurance verification and pre-authorization, coded procedures and managed patient charts.

Managed billing calendar and scheduled claims for payments.

Helped customers to bring accounts into good standing by implementing payment plans.

Completed month-end and year-end closings, kept records audit-ready and monitored timely recording of accounting transactions.

Maintained current and accurate cash balances for all programs, departments and projects.

EDUCATION AND TRAINING

High School Diploma

Norman High School, Norman OK May 1996

Some College (No Degree)

Certified Legal Assistant, City College, Norman Ok

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