Experience

University of Illinois Chicago College of Dentistry
• United States
• Higher Education
• 1 - 100 Employee
• Dental Student

  • Jan 2021 - Present


Hope Clinic for Women in Granite City, IL

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Consultant– Provider Contracting and Credentialing

  • Jun 2019 - Present

  • Implemented contracts for the brand new facility with Medicaid and MCOs for 1 group, 10+providers, 1 location, and developed policy and provider manual for others to follow for best practices • Contracting: Responsible for negotiating for contract rates for private insurance companies, finalizing the contract, getting fee schedule and loading them in the billing system – Eclinicalworks • Credentialing: Responsible for credentialing, CAQH, Medicaid and MCO enrollment, obtaining… Show more • Implemented contracts for the brand new facility with Medicaid and MCOs for 1 group, 10+providers, 1 location, and developed policy and provider manual for others to follow for best practices • Contracting: Responsible for negotiating for contract rates for private insurance companies, finalizing the contract, getting fee schedule and loading them in the billing system – Eclinicalworks • Credentialing: Responsible for credentialing, CAQH, Medicaid and MCO enrollment, obtaining physician privileges and affiliations; • Build relationships with all insurance company representatives for any outstanding issues and resolve them as a delegated entity Show less • Implemented contracts for the brand new facility with Medicaid and MCOs for 1 group, 10+providers, 1 location, and developed policy and provider manual for others to follow for best practices • Contracting: Responsible for negotiating for contract rates for private insurance companies, finalizing the contract, getting fee schedule and loading them in the billing system – Eclinicalworks • Credentialing: Responsible for credentialing, CAQH, Medicaid and MCO enrollment, obtaining… Show more • Implemented contracts for the brand new facility with Medicaid and MCOs for 1 group, 10+providers, 1 location, and developed policy and provider manual for others to follow for best practices • Contracting: Responsible for negotiating for contract rates for private insurance companies, finalizing the contract, getting fee schedule and loading them in the billing system – Eclinicalworks • Credentialing: Responsible for credentialing, CAQH, Medicaid and MCO enrollment, obtaining physician privileges and affiliations; • Build relationships with all insurance company representatives for any outstanding issues and resolve them as a delegated entity Show less



Planned Parenthood of Illinois

• United States
• Hospitals and Health Care
• 100 - 200 Employee

• Business Operations Project Manager

  • Mar 2020 - Present

• Provider Contracting and Credentialing Specialist

  • Oct 2018 - Mar 2020

  Provider contracting and Credentialing Specialist • Solely handling contracting and credentialing for 1 group with 17 practice locations, 17 laboratories; and 90+ providers • Implemented credentialing software to improve the credentialing & contracting process • Initiated billing for behavioral health providers (Improved AR by 3%) • Train 2 employees for credentialing and contracting projects • Participate in writing policy and… Show more Provider contracting and Credentialing Specialist • Solely handling contracting and credentialing for 1 group with 17 practice locations, 17 laboratories; and 90+ providers • Implemented credentialing software to improve the credentialing & contracting process • Initiated billing for behavioral health providers (Improved AR by 3%) • Train 2 employees for credentialing and contracting projects • Participate in writing policy and procedures for the dept. and for Accreditation • Contracting:  Negotiation based on fee schedule and patient flow; executing contracts and updating fee schedule  Schedule biweekly or monthly Illinois MCO meetings for contracting, credentialing or billing issues • Credentialing:  Manage practice and all physicians’ Impact, CAQH, Medicaid, credentialing and re-credentialing applications; and obtaining physician privileges within the selected plans • Billing/ revenue cycle management:  Served as a liaison between Internal Revenue team and external billing vendor  Responsible for claims variance analysis and claims denial management: Work with MCOs and Medicaid to improve Account Receivables (AR) (increased AR by 9%)  Migrated from paper payments to e-payments as a project from all payers within 6 months

• Credentialing Coordinator

  • Dec 2017 - Oct 2018


Planned Parenthood of the St. Louis Region and Southwest Missouri
• United States
• Hospitals and Health Care
• 1 - 100 Employee
• Consultant - Provider Contracting and Credentialing

  • Jan 2020 - May 2022

RevTell Revenue Cycle Management
• Consultant- Provider Contracting & Credentialing

  • Oct 2020 - Nov 2021


Aurora Dentrix Dental Clinic (Dr. Kishor Belani, DDS)

• Dental Assistant

  • Jan 2019 - Sep 2020

   Observe Dr. Belani in general dentistry procedures, including fillings and repairs, root canals, implant placement, post and core, extractions, prosthesis (crowns, veneers, dentures, Invisalign, bridges fabrication, and delivery)  Observe case presentations and engage in case discussions  Assist the dentist by performing four-handed dentistry and other chair-side duties  Perform coronal polishing, flossing, and topical fluoride application, and obtain radiographs … Show more  Observe Dr. Belani in general dentistry procedures, including fillings and repairs, root canals, implant placement, post and core, extractions, prosthesis (crowns, veneers, dentures, Invisalign, bridges fabrication, and delivery)  Observe case presentations and engage in case discussions  Assist the dentist by performing four-handed dentistry and other chair-side duties  Perform coronal polishing, flossing, and topical fluoride application, and obtain radiographs  Responsible for obtaining radiographs (digital and panoramic)  Prepare and organize the operatory and sterilization protocols  Obtain impressions, bite records, and fabricate models  Document all the dental procedures performed during each patient visit in Eagle-soft software  Collaborate with the office manager in insurance and billing  Develop a training manual for dental assistants under supervision Show less  Observe Dr. Belani in general dentistry procedures, including fillings and repairs, root canals, implant placement, post and core, extractions, prosthesis (crowns, veneers, dentures, Invisalign, bridges fabrication, and delivery)  Observe case presentations and engage in case discussions  Assist the dentist by performing four-handed dentistry and other chair-side duties  Perform coronal polishing, flossing, and topical fluoride application, and obtain radiographs … Show more  Observe Dr. Belani in general dentistry procedures, including fillings and repairs, root canals, implant placement, post and core, extractions, prosthesis (crowns, veneers, dentures, Invisalign, bridges fabrication, and delivery)  Observe case presentations and engage in case discussions  Assist the dentist by performing four-handed dentistry and other chair-side duties  Perform coronal polishing, flossing, and topical fluoride application, and obtain radiographs  Responsible for obtaining radiographs (digital and panoramic)  Prepare and organize the operatory and sterilization protocols  Obtain impressions, bite records, and fabricate models  Document all the dental procedures performed during each patient visit in Eagle-soft software  Collaborate with the office manager in insurance and billing  Develop a training manual for dental assistants under supervision Show less



Richardson Family Dentistry

• United States
• Accounting
• 1 - 100 Employee

• Dental observership

  • Jul 2016 - Nov 2017

   Observed Dr. Nishit in general dentistry procedures  Observed treatments: restorative, endodontic, periodontal, minor orthodontic including night guard and Invisalign delivery; prosthodontic including crown, and implant treatment including post and core; and extractions  Assisted in obtaining impressions and model fabrication for Invisalign, CEREC, and prosthesis  Conducted intraoral X-rays to allow diagnosis and monitor ongoing treatments  Developed knowledge… Show more  Observed Dr. Nishit in general dentistry procedures  Observed treatments: restorative, endodontic, periodontal, minor orthodontic including night guard and Invisalign delivery; prosthodontic including crown, and implant treatment including post and core; and extractions  Assisted in obtaining impressions and model fabrication for Invisalign, CEREC, and prosthesis  Conducted intraoral X-rays to allow diagnosis and monitor ongoing treatments  Developed knowledge related to the use of technology, treatment planning, clinical procedures, regulation, patient ethics, and infection control Show less  Observed Dr. Nishit in general dentistry procedures  Observed treatments: restorative, endodontic, periodontal, minor orthodontic including night guard and Invisalign delivery; prosthodontic including crown, and implant treatment including post and core; and extractions  Assisted in obtaining impressions and model fabrication for Invisalign, CEREC, and prosthesis  Conducted intraoral X-rays to allow diagnosis and monitor ongoing treatments  Developed knowledge… Show more  Observed Dr. Nishit in general dentistry procedures  Observed treatments: restorative, endodontic, periodontal, minor orthodontic including night guard and Invisalign delivery; prosthodontic including crown, and implant treatment including post and core; and extractions  Assisted in obtaining impressions and model fabrication for Invisalign, CEREC, and prosthesis  Conducted intraoral X-rays to allow diagnosis and monitor ongoing treatments  Developed knowledge related to the use of technology, treatment planning, clinical procedures, regulation, patient ethics, and infection control Show less



Baylor College of Medicine

• United States
• Higher Education
• 700 & Above Employee

• Provider Relations Representative II / Claims Analyst

  • Jun 2015 - Jun 2017

  • Credentialing and contracting:  Handled solely all credentialing and contracting inquiries from clinical operations, revenue teams and payers for 22+ practice locations and 7 hospitals  Cross-trained staff to increase internal knowledge and expertise regarding credentialing, contracting, denial reasons, and other key revenue cycle issues • Billing:  Monitored and responded to tickets received on the Billing Helpdesk  Implemented Contract Management software to tract… Show more • Credentialing and contracting:  Handled solely all credentialing and contracting inquiries from clinical operations, revenue teams and payers for 22+ practice locations and 7 hospitals  Cross-trained staff to increase internal knowledge and expertise regarding credentialing, contracting, denial reasons, and other key revenue cycle issues • Billing:  Monitored and responded to tickets received on the Billing Helpdesk  Implemented Contract Management software to tract Account Receivables (AR) variance based on Contract Rate and fee schedule  Generated analytical reports of claim denials and variances: provided summary reports to the dept. and leadership team regarding outstanding account projects and worked with MCOs to resolve  Participated in operation meetings to develop, discuss and work on the corrective action plan to address the root cause of the payment variance problems identified in above-mentioned reports

• Project Intern/ project coordinator - Office of President

  • Jun 2015 - Aug 2015

  • Maintained providers’ licenses, certificates, dues, credentialing documents; as well as maintained hospital insurance and collection legislation, HIPAA compliance and regulations. • Responsible for providing basic training for Clinical EMR billing system; and updating fee schedules • Developed various polices and process flows in Visio for internal project team and accreditation • Provided executive support in program management projects, research projects; and in implementing new… Show more • Maintained providers’ licenses, certificates, dues, credentialing documents; as well as maintained hospital insurance and collection legislation, HIPAA compliance and regulations. • Responsible for providing basic training for Clinical EMR billing system; and updating fee schedules • Developed various polices and process flows in Visio for internal project team and accreditation • Provided executive support in program management projects, research projects; and in implementing new initiatives like EMR meaningful use, Adaptive scheduling, and Verbal Intake; and patient retention • Provided executive support in tracking projects, scheduling meetings, creating agenda, taking meeting minutes, distributing summary reports; and developing job description for open positions



Altus Health

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Project assistant - Network Development Department

  • Sep 2015 - May 2016

  • Assisted Contract manager in contract negotiation; resolving contract-related issues • Responsible for handling hospital and physicians licenses, credentialing and re-credentialing applications, and obtaining physician privileges within the selected hospitals and selected health plans • Maintained database and analyzed reports to verify and report on in-network coverage for contracted providers for MCOs’, leadership team and dept. meetings. • Lead and facilitated meetings along with… Show more • Assisted Contract manager in contract negotiation; resolving contract-related issues • Responsible for handling hospital and physicians licenses, credentialing and re-credentialing applications, and obtaining physician privileges within the selected hospitals and selected health plans • Maintained database and analyzed reports to verify and report on in-network coverage for contracted providers for MCOs’, leadership team and dept. meetings. • Lead and facilitated meetings along with developing meeting objectives, agendas; and action items • Planned, coordinated and attended provider communication events and assisted in distributing e-newsletters to investors Show less • Assisted Contract manager in contract negotiation; resolving contract-related issues • Responsible for handling hospital and physicians licenses, credentialing and re-credentialing applications, and obtaining physician privileges within the selected hospitals and selected health plans • Maintained database and analyzed reports to verify and report on in-network coverage for contracted providers for MCOs’, leadership team and dept. meetings. • Lead and facilitated meetings along with… Show more • Assisted Contract manager in contract negotiation; resolving contract-related issues • Responsible for handling hospital and physicians licenses, credentialing and re-credentialing applications, and obtaining physician privileges within the selected hospitals and selected health plans • Maintained database and analyzed reports to verify and report on in-network coverage for contracted providers for MCOs’, leadership team and dept. meetings. • Lead and facilitated meetings along with developing meeting objectives, agendas; and action items • Planned, coordinated and attended provider communication events and assisted in distributing e-newsletters to investors Show less



University of Houston-Clear Lake

• United States
• Higher Education
• 700 & Above Employee

• Instruction Assistant

  • Jan 2015 - Aug 2015

   Assisted teaching faculty in planning curriculum and tests; and record-keeping  Counseled students regarding the course and assignment planning, and skill development  Provided course-related directions to an individual or small groups of students to improve overall academic performance

• Tutor

  • Sep 2014 - Aug 2015

   Reviewed homework assignment and test scores for about 100+ students  Employed study aides to prepare for tests and quizzes, including review notes and videos  Received the “UHCL Tutor of the year” award for Healthcare quality subject Supported around 70 students through an ongoing, one-to-one tutoring and participated in activities together for their academic success in developing efficient skills and competencies regarding management courses.



Dr. Siddharth P Jariwala Dental Clinic

• Associate General Dentist

  • Oct 2012 - Jul 2013

   Conducted oral evaluations, cavity detection, and disease prevention measures  Carried out a comprehensive diagnosis and developed comprehensive dental plans for patients  Provided treatments for a variety of dental problems, conditions, and requirements, including endodontic, restorative, periodontics, prosthodontic, and minor oral surgical procedures  Handled emergencies, including the treatment of serious oral health conditions  Performed x-ray work and used other… Show more  Conducted oral evaluations, cavity detection, and disease prevention measures  Carried out a comprehensive diagnosis and developed comprehensive dental plans for patients  Provided treatments for a variety of dental problems, conditions, and requirements, including endodontic, restorative, periodontics, prosthodontic, and minor oral surgical procedures  Handled emergencies, including the treatment of serious oral health conditions  Performed x-ray work and used other in-office technology to identify conditions and needs  Counseled patients on oral hygiene, brushing techniques, and periodic dental visits  Responsible for sterilization protocols and preparation of operatory  Ensured high level of patient awareness with regard to personal oral hygiene, proper brushing and flossing, annual checkups, and necessary procedures  Built network with other specialists and laboratories to provide best treatment plan to patients Show less  Conducted oral evaluations, cavity detection, and disease prevention measures  Carried out a comprehensive diagnosis and developed comprehensive dental plans for patients  Provided treatments for a variety of dental problems, conditions, and requirements, including endodontic, restorative, periodontics, prosthodontic, and minor oral surgical procedures  Handled emergencies, including the treatment of serious oral health conditions  Performed x-ray work and used other… Show more  Conducted oral evaluations, cavity detection, and disease prevention measures  Carried out a comprehensive diagnosis and developed comprehensive dental plans for patients  Provided treatments for a variety of dental problems, conditions, and requirements, including endodontic, restorative, periodontics, prosthodontic, and minor oral surgical procedures  Handled emergencies, including the treatment of serious oral health conditions  Performed x-ray work and used other in-office technology to identify conditions and needs  Counseled patients on oral hygiene, brushing techniques, and periodic dental visits  Responsible for sterilization protocols and preparation of operatory  Ensured high level of patient awareness with regard to personal oral hygiene, proper brushing and flossing, annual checkups, and necessary procedures  Built network with other specialists and laboratories to provide best treatment plan to patients Show less