Data Entry Service Delivery

Barbara Thomas

Louisville, KY ***** 502-***-****

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

PROFESSIONAL Professional with background in provider services, skilled in managing provider SUMMARY networks and ensuring adherence to quality standards. Proven ability to enhance service delivery through effective onboarding and issue resolution. Experienced with provider data management and regulatory compliance. Utilizes strong organizational and communication skills. Knowledge of problem-solving techniques.

• HIPAA compliance •Claims processing

• Insurance verification •Analytical thinking

• Team building •Outlook

• Excel •Microsoft Word

• Printers/Fax Machines •Strong PC

• Receptionists Desk •Internet Explorer

PROVIDER ENROLLMENT COORDINATOR 02/2018 to 01/2024 WellCare Louisville, KY

• Load providers to business/groups in management systems, ensuring accuracy and timeliness.

• Adapted quickly to updates in enrollment software and systems, enhancing operational efficiency.

• Provided routine administrative support, contributing to overall team productivity and effectiveness.

• Established strong relationships with providers.

• Used Systems CAQH, facets, cactus, license verification site etc.

• Developed expertise in company-specific software tools and trained in fraud awareness classes.

• Assisted in loading physicians to provider maintenance forms by processing time efficiently reviewing and verifying provider credentials.

• Supported data entry into provider management systems, ensuring accuracy and timeliness.

• Expedited the resolution of discrepancies or missing information through diligent follow-ups with providers.

• Communicated effectively via telephone, email, fax or mail.

• Checked documentation for accuracy and validity on updated systems.

• Verified client information by analyzing existing evidence on file.

• Maintained strong knowledge of basic medical terminology to better understand services and procedures.

SKILLS

WORK HISTORY

• Carried out administrative tasks by communicating with Providers, distributing mail, and scanning documents.

• Learned compliance regulations related to provider credentialing and enrollment procedures. NETWORK PROVIDER SPECIALISTS 04/2012 to 10/2016

Anthem BC & BS Louisville, KY

• Managed provider database, ensuring accuracy of information and timely updates for operational effectiveness and improving workflow efficiency.

• Enhanced customer satisfaction by addressing provider concerns and resolving issues promptly.

• Managed a portfolio of providers while effectively handling multiple priorities and deadlines.

• Developed strong relationships with providers.

• Maintained up-to-date knowledge of industry changes as well as new system updates.

• Educate providers on submitting Provider Maintenance Forms (PDF) to make any changes, updates, to terming or loading new groups and providers.

• Performed various administrative tasks by filling, phone calls, emails, mailing letters, copying or faxing documents.

• Ensuring we have all documents needed and Verifying providers information, licenses and credentials needed.

• Ordering Supplies and stocking supply room for entire team.

• Worked Provider Maintenance Forms (PDF) for New Providers, Changes/Updates and PT, OT, SLP.

• Emergency (ER's), Clinics and Hospitals etc.

• Pulling and working reports.

• Auditing co-workers.

• Training co-workers and new hire employees

SENIOR CLERK 06/2006 to 04/2012

Anthem BC & BS Louisville, KY

• Oversaw daily clerical operations, ensuring accurate data entry and enter reports on excel.

• Resolved complex administrative issues through analytical problem-solving and critical thinking skills.

• Pulling applications, rescans, mailing letters, COB’s/EOB’s, appeal letters, individual scanned box, answering phone calls, maintenance for all fax/copy machine returned mail, responsible for faxes, and prescreen/opinions.

• Prioritized workload effectively managing multiple tasks at once maintaining focus under pressure while meeting deadlines consistently.

• Support for underwriters

CLAIMS AND BILLING PROCESSOR II 01/1997 to 06/2006 Anthem BC & BS Louisville, KY

• Managed customer inquiries regarding billing discrepancies issues.

• Worked HCFA's and UB's claims with or without EOB’s

• Processed Medicare, COB's, subscriber claims and correspondence claims.

• Assisted team lead with researching missing batches, routing, prepping and assisted in mailroom.

• High production environment with established goals for production and quality.

• Responsible for efficiency and accuracy of claims satisfaction.

• Keyed claims from image using OCR and KFI database.

• Pulled rejected claims from an EDI RTP report.

• Retrieved claims using ADHOC system and microfilm. EDUCATION Southern High School,, Louisville, KY

REFERENCES David Lipsky 502-***-****

David Coleman 502-***-****

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