Experience

La Perouse Billing

• United States
• Financial Services
• 1 - 100 Employee

• Credentialing Specialist

  • Jun 2022 - Present

  * Complete credentialing, re-credentialing applications, and/or enrollments of health care providers Facilitates EDI, EFT, Claims, NPI, and payor enrollment for Medicare, Medicaid, and Commercial payors. * Assist the accounts receivable team with the initial applications for ERA enrollment, maintaining accurate and current provider enrollment data, and updating rosters with payers and health plan directories. * Assist in enrollment issues as they relate to ERA payer enrollment and claims payments * Work closely with AR, Credentialing, and Payor Relations teams to collect all items needed to obtain and maintain ERA payer participation * Keeping in touch with all payors in accordance with established guidelines for all credentialing assignments * Maintain and update online database Show less



UST

• United States
• IT Services and IT Consulting
• 700 & Above Employee

• Senior Process Associate

  • Oct 2021 - Jun 2022

  Intake Credentialing Specialist• Create and carry out various credentialing processes in relation to physicians, medical assistants, and various other healthcare professionals. • Process applications and reappointment paperwork, checking for full completeness and accuracy.• Collect and process significant amounts of verification and accreditation information, and thus must constantly maintain and update accurate databases for Medical Practitioners.• Assist with obtaining copies of all required documents from health care providers including, but not limited to, medical licenses, DEA registration, copies of degrees, board certifications and other required documents• Ensure that all personnel and services adhere to facility and staff policies, department guidelines, regulations, and government laws. • Maintain confidentiality of provider files. Intake Appeals Specialist• Analysing the fax document and determining it whether the fax is an appeal or a supporting documentfor an existing appeal.• Determining and analysing the document to determine the reason of appeal. • Triage and entering of appeal request and properly routing the request that will handle it. Show less

• Process Associate

  • May 2018 - Sep 2021

  Claim Processor• Enter claims data into system. Follow adjudication policies and procedures to make sure proper payment of claim Ensure that all personnel and services adhere to facility and staff policies, department guidelines, regulations, and government laws.



Imagenet LLC

• United States
• Business Consulting and Services
• 100 - 200 Employee

• Assistant Team Lead

  • Oct 2017 - May 2018

  • Working with team lead to perform all tasks within the claims team. • Assume the responsibility of the Team Lead when he/she is not around • Monitor team performance and report on metrics

• Medical Claims Examiner

  • Apr 2015 - Oct 2017

  • Accurate claims adjudication as per policy terms and conditions• Accurate claims adjudication as per agreed business SOP and within agreed SLA’s.• Review and evaluation of medical costs and service line iterms• Review and evaluation of medical codes, supporting documents and observations to determine medical appropriateness.



Accenture

• Ireland
• Business Consulting and Services
• 700 & Above Employee

• Claim Processor

  • May 2011 - Jan 2014

  • Process claim forms, adjudicates for provision of deductibles, co-pays, co-insurance maximums and provider settlements. • Entered claims data into system. • Resolved problems resulting f rom claim settlement. • Performed audit of randomly selected claims to ensure quality processing. • Research claim overpayments and requests funds. • Followed adjudication policies and procedures to make sure proper payment of claim • Process claim forms, adjudicates for provision of deductibles, co-pays, co-insurance maximums and provider settlements. • Entered claims data into system. • Resolved problems resulting f rom claim settlement. • Performed audit of randomly selected claims to ensure quality processing. • Research claim overpayments and requests funds. • Followed adjudication policies and procedures to make sure proper payment of claim