Insurance Operations Manager

• Jul 2021 - Present

Healthcare Credentialing Specialist

• Aug 2019 - Present

Healthcare Credentialing and Contracting services with MD, DO, NP, PA, RD, OT, PT, Behavioral Health etc. Medicare, Medicaid, Commercial payers. Licensing, Contract negotiations, Fee schedule analysis. ASC contracting and credentialing also available. Healthcare Credentialing and Contracting services with MD, DO, NP, PA, RD, OT, PT, Behavioral Health etc. Medicare, Medicaid, Commercial payers. Licensing, Contract negotiations, Fee schedule analysis. ASC contracting and credentialing also available.

Healthcare Credentialing-Contracts Manager

• Jan 2020 - Jun 2021

My position was Credentialing Manager. I completed all credentialing and contracting for all of the Registered Dietitians with Medicare and all Commercial payers . I completed CAQH profiles for 25+ providers in over 21 states. I completed the NPI setup for providers. if the provider did not have one established when onboarding. I completed all Medicare enrollments for the group via Pecos in each state as well as the enrollments of the individual Registered Dietitians. I was responsible for the Primary Source Verification with the National Provider Data Bank on all providers and led the Delegated Credentialing committee monthly meetings. I also handled licensing in multiple states for multiple providers. I assisted the operations team with incoming phone calls, scheduling appointments, submitting claims via Advanced MD and completed all ERA, EDI, EFT setup for all insurance payers. When time allowed, I assisted the marketing team with calls to prospective clients. Unfortunately the company ceased operations due to Covid19.

Credentialing, Enrollments Manager and Managed Care Contracting

• May 2014 - Aug 2019

At National Medical Billing Services my position was the Manager of the Credentialing department. Credentialing included enrollments for Ambulatory Surgery Centers in the United States as well as Medical physicians (Medical Doctor/Doctor of Osteopath, Anesthesiologists, Nurse Practitioners, Certified Registered Nurse Anesthetists, Chiropractors, Physician Assistants and Registered Nurse First Assists with Medicare, Medicaid, Commercial payers including Durable Medical Equipment (DME) sites. I served as the Manager of all enrollments including Electronic Data Interchange (EDI), Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT) with multiple clearinghouses and lock box-bank changes with payers. I also worked with the Managed Care Contracting team analyzing and negotiating contracts with payers, charge master review and analysis for providers and Ambulatory Surgery Centers and professional providers. I worked with Medicare, Multi-state Medicaid, Commercial payers, PIP and Workmen's Compensation. I handled all Medicare inquiries with PECOS (Medicare Provider Enrollment, Chain, and Ownership System) including new 855 enrollments and revalidations. Providers and Ambulatory Surgery Centers include but not limited to specialties of Pain management, Orthopedic, Ophthalmology, Urology, Gynecology, Cardiology and Anesthesia. Responsibilities also include researching State laws in various areas involving healthcare insurance and licensing. I also was responsible for the individual provider (CAQH) Council for Affordable Quality Healthcare profiles for many provider and/or groups . I also assisted in on-boarding new clients, I served as a Tiger team member assisting with implementing and served as a resource for clients with Medicare, Medicaid as well as other payers. I also assisted with training in the Credentialing, Enrollments and Contracts department.

Medical Healthcare Credentialing and AR Manager for RHC and FQHC's

• Jun 2008 - Apr 2014

Responsibilities included Credentialing Providers and Healthcare Clinics with Medicare Part A and B, Multi state Medicaid and Commercial payers for multiple RHC (Rural Healthcare Centers) and FQHC (Federally Qualified Healthcare Centers) entities and physician billing for specialty practices including Gastroenterology. In addition, responsibilities included coding services, charge posting, payment posting, working account denials, calling payers for accounts receivables and contacting insurance companies with appeals. Claims submissions and follow-up on any rejections. Assist with implementing new clients with billing services. Training new staff on software systems and other positions of the revenue cycle.

Billing office

• Jun 2006 - Jun 2008

My position included assisting the billing office manager with revenue cycle billing, assisted the patients in the front and back office as needed as well as all the providers in the office including 2 physicians and 4 Nurse practitioners. I assisted with patient calls, chart review with providers and prescription refills. I was responsible for opening the office daily for incoming staff and patients. My position included assisting the billing office manager with revenue cycle billing, assisted the patients in the front and back office as needed as well as all the providers in the office including 2 physicians and 4 Nurse practitioners. I assisted with patient calls, chart review with providers and prescription refills. I was responsible for opening the office daily for incoming staff and patients.

Practice Manager-Urology Practice

• Oct 2000 - Jun 2006

Responsibilities as the practice manager included managing a multi-physician Urological-Surgical practice. My position included coding all provider charts, charge posting, payment posting, Accounts Receivable follow-up and daily bank deposits for the office. In addition, I was responsible for all Inpatient and Outpatient billing and appeals with Insurance payers, scheduling patient diagnostic studies and surgical procedures, performed all pre-certifications on all procedures and surgeries with payers. I credentialed all new providers with insurance payers including Medicare using PECOS, Medicaid and Commercial payers. Assisted providers as needed with patients and did follow-up on patients post surgically. Patient phone calls including appointment verification, calling out patient prescriptions, discussing accounts and other research. I also ordered all surgical supplies and office supplies for the office. I was responsible for the entire revenue cycle billing and overall staffing including hiring and release of employees. I was responsible for the opening and closing of the office for staff and patients. I was also responsible for the recovery of accounts that were thought to be lost revenue with the payers that were billed incorrectly and followed up on that were over 365 days on the accounts receivables. With my strong expertise, I was able to recover the revenue from the payers. I also challenged Medicare on a large recovery on behalf of the providers and won the case for the providers.

Office Manager

• Oct 1990 - Sep 2000

I was the Office manager for a multi-physician family practice group. Responsibilities included to answering phones, assisting patients with refill requests and patient call backs, intake on calls from nursing staff and providers and called in medical orders per the physician. I was responsible for the daily deposits, charge entry and payment entry, follow-up on account receivables and worked all insurance denials including appeals, collection accounts, claims submissions for all payers with the clearinghouse. Training of new employees, credentialing and re-credentialing for all physicians including Medicare, Medicaid and Commercial payers. I managed the setup of the clearinghouse for claims and the new software systems. and trained staff on the software programs. I was also responsible for opening and closing the office for staff and patients.