Administrative Contract Compliance & Credentialing

Cassandra Thompson

**** ********** ******, ********, ** 75149 214-***-**** ************@*****.***

CAREER SUMMARY

Administrative support professional

3+ years of experienced in contract compliance/credentialing, workmen comp claims.

Over 12+ years of experience in corporate purchasing, inventory control, account management, vendor relations, corporate payment specialist, accounts payable\receivable

My skill set includes strong communication, negotiation, organization, team player and the ability to manage simultaneous projects and successfully meet deadlines

WORK EXPERIENCE

GENESIS PHYSICIANS GROUP Dallas, Texas August 2013-2017

Contract Compliance Representative

Reviewed Physicians Plan Submission packets and Opt in request prior to submission for accuracy and completeness.

Research, negotiated and resolves physician effective date issues between physicians and health plans

Prepared and sent weekly/monthly Reports to health plans

Maintain tracking records of reports sent to payers to ensure providers effective dates are received timely within 30-90 days

Attends Health Plan Joint Operation Committee meetings, preparation of agendas and minutes from meetings

Advises and obtains necessary documentation/forms from physician reps to provide to health plans for opt ins, opt outs, adds, changes, terms (ACT) Report within the contract requirements

Review reports, update and maintain database for contract compliance and NSQA requirements

Maintain confidentiality of all providers information. HIPAA Training, Code Of Conduct, CMS Compliance 2016

Credentialing Coordinator

Review and process monthly TSCA application for re-credentialing physicians

Managed 1300 physicians/allied health professionals license, site reviews and NPDB for NCQA compliance

Responsible for the review and analysis of practitioner TSCA applications and accompanying documents, ensuring applicant eligibility

Conducts research and primary source verification of all components of the application file

Utilizes Apogee Systems to process and maintain expirables and query reports

Attend and prepares credentials file for completion and presentation monthly to Genesis Peer\Membership Committees, ensuring file completion within time compliance policies

KOG, INC. Dallas, Texas July 2012-2013

Administrative Director

Receives and verify contract and applications for program requirements, and contacts candidates for any additional supporting documentation or clarification.

Reviews and verify applications to ensure the candidates meet basic eligibility requirements.

Calls supervisors and peers to obtain verbal references for contracts.

CCSI HOLDINGS LP Irving, Texas November 2009-2011 Federal Workman’s Compensation Claims Specialist

Verify, research, and respond to telephone inquiries and written inquiries, from providers, insurance companies and other departments, pertaining to credentialing and claims status in a professional and courteous manner.

Verify and settle claims related to bodily injury, general liability, and public.

Coordinated communications with claimants, mediators, and physicians to ensure the process for compensation within the federal guidelines and regulations.

Handle special investigations involving fraud and questionable circumstances.

Monitor and review incoming bills for related to compensable injuries.

Open a new claim, verify coverage, do a 3 point investigation and take a recording if needed.

Credentialed for Physician Offices, Attorneys, and Employers/Human Resources during the verification process of the claim, legal concerns, and return to work status.

CONFERENCECALL.COM Carrollton, Texas April 2006-2009

Account Manager

Worked daily and collaboratively with executive sells associates and potential customers.

Utilized internet leads and SalesForce System to generate and promote sales.

Verify and screened new accounts application via online and fax.

Managed customer accounts, inquiries and processed monthly credit reports.

Neiman Marcus Dallas, Texas March1999-2003 Corporate Precious Jewelry Payment Specialist

Worked daily with department managers and sell associates with system inventory updates.

Managed and maintain various and numerous vendor accounts, analyzed reports and consignment products, Submitted store to store transfer/return merchandise to vendors, Process billing for over twenty-nine establishments nationwide, updated data using PJ system for markup/markdown on owned and consigned merchandised, reconciled accounts for quarterly and annually fiscal year periods, worked with top executives throughout Neiman Marcus, Prepared budgets and forecasts for area divisional managers.

Corporate Purchasing Buyer/Print Specialist August 1991- 1999

Credentialed for vendors and top executives within the Neiman Marcus Group to successfully launch and market new merchandise. (Neiman Marcus, NM Direct, Laura Mercier, Kate Spade and Horchow)

Researched market for product comparison, assist preparation for RFQ's, analyzed data, and worked with graphic designers and printers to ensure quality customer service to internal and external customer.

Managed warehouse printing goods distribution, inventory; prepared budgets and forecasts for divisional managers.

SPECIAL SKILLS:

Proficient in Microsoft Outlook, Word & Excel,

MSAS SYSTEM

Accounting Savvy

SALESFORCE

APOGEE

Education

University of Houston

1998

Allstate Business College

1987-1988

References will be furnished upon request

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