Provider Enrollment Specialist

• Jan 2022 - Present

Enrolling providers with various insurance plans. Enrolling providers with various insurance plans.

Credentialing Coordinator

• May 2021 - Jan 2022

Credentialing MD's, DO's, PA's, APRN's, LCSW's, DMD's and DDS' for a FQHC.

Payment Poster

• Feb 2021 - May 2021

Financial Clearance Specialist

• Aug 2019 - Jul 2020

Remote positionObtaining authorization for Radiologic and Surgical proceduresVerifying medical benefit eligibility Remote positionObtaining authorization for Radiologic and Surgical proceduresVerifying medical benefit eligibility

Beneficiation Specialist

• Aug 2016 - Aug 2019

Responsible for reviewing patients’ case and insurance coverage informationWork cordially in a team and participate in meetings, sharing ideas and information.Ensure all patient files are available for daily verification of insurance benefits by printing census.Request pre-certification and benefits for outpatient procedures.Perform verification of Medicare coverage.Initiate authorization for medical procedures via internet or fax.Trained new employees.Request clinical information for authorization determination as well as peer to peer reviews.

Member Service Representative

• Aug 2015 - Aug 2016

Interacts with customers to provide information in response to inquiries about products and servicesTransfer customer calls to appropriate departmentsIdentify, research, and resolve customer issues Follow-up on customer inquiries not immediately resolvedResearch member billing and claims issuesResearch payment and member refund issuesHandle and resolve customer's complaintsAbility to navigate through automated information systems to analyze the caller’s situationExplains in a way the customer can understandServes as liaison between the customer and various departmentsOther duties as assigned by the management team related to job functions (sort incoming faxes, correspondence, fax transportation forms, etc.)Required to work some overtime as the business requiresRequired to work flexible schedules (nights, weekends), or change schedules - as it is determined based on the needs of the business, which are subject to change

Data Entry Clerk

• Oct 2014 - May 2015

Enter data from consent formsPosting payments from health insurance companiesInternet researchVerifying insurance claims status' via Availity as well IVRVarious duties as assigned Enter data from consent formsPosting payments from health insurance companiesInternet researchVerifying insurance claims status' via Availity as well IVRVarious duties as assigned

Credentialing Coordinator

• Nov 2012 - 2014

Process physician credentialing application's from Data Entry through Quality Assurance.Review applications for completeness and data credentialing information based on client needs, contractual requirements and credentialing standardsIdentify missing information based on credentialing standards and client requirementsInitiate collection of missing informationPerform primary source verificationsMaintain departmental production and accuracy goalsTeam with peers for effective and efficient workflowMiscellaneous Department Transfer-followed up on requests for missing information via phone call, fax and emailPosted information to file once receivedQuality Assurance Department Transfer-review files for completion following URAC, NCQA and JCHO standardsRequest any information that is still in questionAdhere to 45 day completion timeEnsure files are correct and complete before submitting to client

Administrative Assistant

• Oct 2010 - Aug 2012

Opening cases for clinical review in File Maker and Case Trakker systemsScanning documents and attaching them to cases in File Maker’s systemAppeals Coordinator-Managed appeals including intake and follow upScanning medical records for retentionAssisted in obtaining URAC accreditationCreating and Maintaining Excel SpreadsheetsAssisted in Medical TranscriptionBinder production (Policy & Procedure Manuals) Opening cases for clinical review in File Maker and Case Trakker systemsScanning documents and attaching them to cases in File Maker’s systemAppeals Coordinator-Managed appeals including intake and follow upScanning medical records for retentionAssisted in obtaining URAC accreditationCreating and Maintaining Excel SpreadsheetsAssisted in Medical TranscriptionBinder production (Policy & Procedure Manuals)