Data Entry Clerk

Megan D. Embrey, MBA

**** ****** *****, *********, ** 37076

Cell 615-***-****

********@*****.***

PROFESSIONAL PROFILE

Accomplished healthcare professional with over 15 years of experience in the healthcare industry that will give me the

opportunity to continue educating myself in the health care field. A detail oriented and energetic team player who is capable

of working on own initiative along with ability to produce accurate work. I am looking to build upon my experience and

knowledge in healthcare in order to move forward professionally based on my consistent achievements.

SKILL HIGHLIGHTS

Significant healthcare credentialing experience Research and analyze data

Team player Prioritize work and manage multiple assignments

Accurate and efficient Maintain effective working relationships

Detail-oriented and well-organized Proficient use of Microsoft Office applications

SOFTWARE PROGRAMS

CACTUS OnBase

Artiva 4.0 Medic/MedWare

Relay Health SyMed OneApp Pro

eClinicalWorks (ECW) MD-Staff

Vistar CARE-Newport Credentialing

PECOS CAQH

Echo OneApp VerityStream

UltiPro SProvider (Symplr Provider)

PROFESSIONAL EXPERIENCE

Vanderbilt University Medical Center

Credentialing Coordinator August 2020-Present

Perform and collect PSV (primary source verification) documentation for licensing, board certifications,

proof of malpractice insurance and claim history

Request NPDB report via SProvider

Verify education via AMA

Verify if the provider is credential with current or previous work history

Maintain working knowledge of the National Committee on Quality Assurance (NCQA) standards and State and Federal regulations related to credentialing

Credential initial and recredential providers through Symplr Provider

Performs primary source verification for providers

Run affiliation letters through different healthcare institutions websites

Maintain the credentialing database via Cactus and ensure up-to-date information is obtained

Ensures appropriate documentation is maintained and that information is easily retrievable

Acadia Healthcare

Credentialing Coordinator March 2020-August 2020

Prepare and submit initial and re-credentialing documentation

Track and monitor incoming and outgoing credentialing requests, including maintenance of credentialing files

Maintain various database systems (VerityStream and UltiPro)

Prepare and submit Medicaid enrollments and re-validations

Work directly with the Contracting Department to resolve disputes

Prepare and administer routine correspondence, memoranda and notifications

Work closely with the Contracting Department to ensure efficiency of processes and create new workflow tools as needed

Update and maintain in-house documents

Ensure accuracy of providers credentials by doing primary source verification of state license, DEA, board certification etc.

Add new clinics and providers in VerityStream as needed

Track and validate documents in Data Validation Grid

American Physician Partners June 2019-March 2020

Provider Enrollment Specialist

Knowledge of PECOS by submitting 855I and 855R applications.

Submit enrollment applications for Ohio, Michigan, Tennessee and Virginia.

Update and upload documents that are expired in CAQH

Add practice locations in CAQH

Maintain the active roster for the Provider Enrollment Facilities when enrolling the provider with the payor.

Receive emails from CAQH to update and re-attest the provider’s profile.

Contact the credentialing department to request items that are needed to enroll the providers with the payors.

Create and maintain proper tracking/workflow in the Provider Enrollment software application EchoOneApp.

Review correspondences received from the payors and providers and perform appropriate action to resolve.

Appropriately resolve or escalate payor application denials.

Updating the SOPs (Standard Operating Procedures) for Michigan, Tennessee and Virginia.

Maintain working knowledge of workflow, systems and tools used in the department.

HCA Physician Services Group

2016-2019

Treasury Specialist March 2018-June 2019

Reviewing DPRs (Daily Practice Reconciliation) reports for posting accuracy to patient accounts, deposit receipts, credit card receipts, and end of day payment reports.

Provide support to other cash management departments for accuracy on lockbox, EFT, and ERA payment postings.

Provide support to the accounting department during the end of month close.

Research deposit vs posted items for adjustments/corrections to patient accounts

Assist practice support in transferring/correcting patient payments

Research items for accuracy using HCA Enterprise Analytics Library (HEAL) that includes Payment Batch Detail and Receipt Summary

Experience working with various software programs, (ecW launcher, Dashboard, Cash Management Tool, OnBase, CashPro, and Treasury Tool)

Electronic Data Interchange (EDI) Payor Response Specialist June 2017-March 2018

Perform claim research and analysis to resolve payor responses (i.e. 276/277

Transactions and 835/Explanation of Benefit (EOB) Claim Adjustment Reason

(CAS) codes) in accordance with department policies and procedures

Initiate telephone calls to payors with respect to claim errors, provider enrollment,

patient eligibility and claim status, utilizing proper customer service protocol

Review correspondence received and performed appropriate action resolve

Meet and maintain established departmental metrics for production 95% and quality

Maintain working knowledge of workflow, systems and tools used in the department

Looking up a patient and provider information via Artiva 4.0 to see about a claim review

Knowledge of Relay Health to look up claims to see if there is an EOB and the reason why the claim was denied

Knowledge of ECW (eClinicalWorks) to find the patient’s insurance card to see if it matches what is in the payer website

Provider Enrollment Application Process Representative June 2016-June 2017

Processed all new and established provider/group Payor applications in Cactus software

Updated Provider/Payor records in Cactus software.

Maintained the accuracy of provider’s information in CAQH Proview.

Used Outlook to establish close working relationships with credentialing coordinators and Payor contacts to request additional information and/or send the necessary documents to get the providers enrolled.

Understand specific application requirements for each Payor including pre-requisites, forms required, form completion requirements, supporting documentation (DEA, CV, etc.), and regulations.

Created spreadsheets with the use of Excel to follow up on the providers.

Maintained providers’ demographic updates have been changed.

Used OnBase Application to retrieve mail; saved corresponding emails and provider enrollment applications.

Sent out notification letters to Payors on demographic changes (ex. Add location; term location; address changes; term from Tax ID).

Reached and maintain established departmental metrics for production 100% and quality

Comprehensive Pain Specialists (CPS)

Provider Enrollment Specialist November 2015-April 2016

Set up and maintain provider information in online credentialing software SyMed Echo OneApp Pro.

Performed follow-up with the payers as needed to research and resolve provider enrollment issues.

Performed follow-up with insurance payers via phone, email or website to resolve provider enrollment issues.

Managed the completion and submission of provider enrollment applications.

Performed tracking and follow-up to ensure provider numbers are established and linked to the appropriate group entity in a timely manner.

Understand specific application requirements for each payer including pre-requisites, forms required, form completion requirements, supporting documentation (DEA, CV, etc.), and regulations.

Maintained documentation and reporting regarding provider enrollments in process.

Retained records related to completed provider enrollments.

Established close working relationships with credentialing coordinators, contracting department, medical management, and payer contacts.

Assisted with a variety of special projects such as finding out the requirements to enroll in a physician owned lab with the payer.

Performed other duties as assigned.

Community Health Systems (CHS)

Provider Enrollment Specialist February 2015-November 2015

Communicated to the designated contact person of the needed paperwork necessary to begin application process for new practitioners

Researched to gather all details to appropriately enroll the practitioner

Obtain completed “Notification Form” from the practitioner contact for every practitioner for which services are requested

Input and retrieve data in the credentialing/provider enrollment system VISTAR within a required timeframe

Obtain copy of CHS provider contact which notes the employer and type of contact arrangement

Obtain checklist items in a timely manner for each practitioner

Maintain contact with designated contact person to obtain application signatures, and collect all required attachments to include with completed applications

Input provider enrollment information and scan all related enrollment documents into CARE-Newport Credentialing Solutions

Contact insurance plans to request provider enrollment application packages

Follow-up with insurance plans by telephone or email until all provider numbers are issued

Maintain physician CARE records in proper manner by scanning copies of all correspondence, linking documents to the appropriate payer screen and documenting notes in payer screen note fields

Prepare and distribute “Provider Grid” to designated contact person for each provider to communicate the progress of approved provider numbers. Ensure the Provider Grid is prepared and distributed each time and update occurs

Perform re-credentialing for providers as needed

Complete applications for new acquisitions

Complete applications for Medicare, Medicaid, Fee for Service and Commercial enrollment

Use of PECOS to complete Medicare applications

Complete required forms and applications for changes in billing systems

Corizon Health

Senior Credentialing Coordinator May 2007-January 2015

Overseen the dispensing of credentials for the practitioners, nurse practitioners and physician assistants of a correctional healthcare organization

Responsible for coordinating, monitoring and maintaining the credentialing and re-credentialing process

Compiled and maintained current and accurate data for all providers

Checked certifications and licenses, and made sure all credentials are current

Distributed a monthly expired credentialing report to the executives and other healthcare employees to assess the credentials that are overdue and will expire in the next 30 days

7 years of experience NCQA policies and procedures

Scheduled and supported (prepares agenda, attends and prepares minutes) the Credentialing Committee

Input the practitioners and mid-levels information into the MD Staff software

Scanned application and credentials in the practitioners and mid-levels folder

Monitored status of pending credentials

Followed up to obtain missing information as needed

Cimplify

Externship

Medical Billing & Coding July 2009-September 2009

Attached primary explanation of benefits (EOB’s) to secondary claims

Adjust Medicare payments to patients’ accounts through Misys Vision/Optimum 8.0

Called insurance companies to check status of patient’s claims

Looked up EOB’s through CIMVIEW

Input the status of patients’ claim on the procedure code through Misys Vision/Optimum 8.0

Howell Allen Clinic

Charge Entry Coordinator/Cash Application Specialist October 2005-May 2007

Performed cash application functions relevant to patient financial services

Balanced control logs and daily deposits

Accurately identifies and posts payment and adjustment transactions to patient accounts, client accounts, and

to the general ledger

Posted electronic remits from third party payers to the patient accounting system

Completed control log and balancing receipts for bank deposit; Verified patients’ insurance and payments through Misys PM

Dr. Ronald McFarland M.D. & Dr. Everton Arrindell M.D

Medical Receptionist August 2001-October 2005

Checked in and outpatients

Posted charges to patients’ accounts and billed to correct insurance

Verified patients’ insurance coverage through use of the Passport

Performed clerical duties to facilitate efficient flow in the front office

Obtained referrals of incoming patients; Knowledge of Medic/Medware practice management system

Recorded accurate messages and relay to proper parties

Scheduled, rescheduled and confirm appointments for in-office visits

Prepared new patient charts and update current patient information

Filed correspondence of patients’ information (i.e., referral letters, lab operative reports, ect). Answered multi-line phone system

EDUCATION

Medical Billing and Coding Program December 2008-September 2009

Kaplan Career Institute Nashville, Tennessee

Recipient of Dean’s List and Perfect Attendance Awards

MBA/HealthCare Management April 2003-March 2005

University of Phoenix Nashville, Tennessee

B.B.A./Business Information System August 1999-December 2001

Tennessee State University Nashville, Tennessee

Associate Degree/Business Administration August 1995-June 1999

Sinclair Community College Dayton, Ohio

CERTIFICATIONS/AWARDS:

CPR Certified American Heart Association

Health Insurance Portability and Accountability Act (HIPAA) trained

Medical Law and Ethics

Contact this candidate