Experience

Decypher

• United States
• IT Services and IT Consulting
• 1 - 100 Employee

• Credentialing Specialist/Corporate Office

  • Jul 2022 - Present

• CVO/Credentialing Administrative Assistant

  • Apr 2022 - Jul 2022



Brooke Army Medical Center

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Medical Records Technician & Patient Referral Coordinator

  • Jan 2020 - Jan 2022

  Daily reporting of Civilian ER admissions. Obtain signed release forms to include medical insurance and patient demographics. Verify insurance utilizing commercial portal websites. Utilize Essentris Clinicomp program to determine ICD-10 diagnosis. Forward authorizations to Utilization Review Nurse and caseworkers for submission of documentation of treatment to payer. Set-up patient demographics and enter verified insurances in ABACUS program for accurate billing and collections. Responsible for obtaining authorizations for all civilian Readmissions and outpatient surgeries including Burn Unit ward Show less



CnStaffing Inc

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

• Human Resources Coordinator

  • Mar 2019 - Sep 2019

  Work closely with Recruiters, Account Managers, and Business Development Manager to coordinate onboarding and interview process. Complete new hire paperwork, application, associated documentation, skills testing, and Osha & Hipaa evalutations. Coordinate criminal background, drug screenings, and other third party sourcing and documentation. Take ownership of new hire until complete. Stay engaged with employees. Engage with Account Managers on specific orders; assist to insure targeted candidates have all necessary documenation. Primary point person receiving incoming calls. Support Administrative Manager as needed to retrieve pay sheets for upcoming payroll; respond to any Field employee questions related to payroll, benefits, or challenges, respond as needed. Show less



Conscience VC

• United States
• Venture Capital and Private Equity Principals
• 700 & Above Employee

• Home Services Specialist

  • Jun 2018 - Mar 2019

  Part-time: Provide house cleaning, pay bills, upkeep of taxes, yard and automotive maintenance for OTR truck driver. Part-time: Provide house cleaning, pay bills, upkeep of taxes, yard and automotive maintenance for OTR truck driver.



Blue Cross and Blue Shield of Illinois, Montana, New Mexico, Oklahoma & Texas

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Credentialing Quality Control Specialist

  • Feb 2016 - Mar 2018

  Perform credentialing/recredentialing quality review for all Provider types, enrollment in production environment for five (5) states. Responsible for ensuring accuracy of auditing and data entry. Document quality performance audits. Utilized by management for training support to auditors, regarded as subject matter expert. Communicated effectively with providers, support team and upper level management. Follow changing policies/procedures and compliant with all federal, state and external accrediting agency regulations and standards: URAC, NCQA, MCO, and CVO. Actively participates in the credentialing department quality improvement program, maintaining or exceeding timeliness, accuracy and production standards. Works in collaboration with all Physician Service Representatives to process applications in a timely manner to meet Membership and Peer Review requirements. Show less

• Credentialing Auditor Rep. II

  • Mar 2013 - Feb 2016

  Perform initial credentialing and re-credentialing according to accreditation standards for all Provider types. Ensure application is complete and accurate, Complete Primary Source Verification for education, training, State License, NPDB, DEA, DPS, Medicaid Sanction and Medicare Sanctions. Secure copy of malpractice claims history, and document work history correctly for public Provider Database. Performs relevant data entry into the credentialing database to ensure consistency and integrity of the data. Actively participates in the credentialing department quality improvement program, maintaining or exceeding timeliness, accuracy and production standards. Works in collaboration with all Physicians and Service Representatives to process new applications in a timely manner to meet Membership and Peer Review requirements. Ensures that all health care professionals data and Protected Health Information (PHI) is maintained, transmitted, and stored in a confidential and secure manner in compliance with applicable state and federal regulations, HIPAA, and BCBS policies and procedures. Performs other duties assigned in an efficient, effective and cost conscious manner. Show less



McKesson

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Patient Services Rep/Medical Billing

  • Nov 2007 - May 2009

  Conduct soft collections on past due accounts in a call center office. Assist incoming patient calls to research & resolve payment and claims issues. Contacts government or commercial healthcare insurance companies to follow up on outstanding accounts receivable. Identify billing errors for correction and resubmit claims to insurance carriers. Follow up on payment errors, low reimbursement, and denials. Review insurance EOB’s and initiate appeals as necessary. Print and mail UB04s or HCFA 1500s as necessary for account resolution. Maintain daily log documentation, verify benefits with insurance, provider and patient for finance negotiation. Identify and report problems or trends. Keep current with all commercial and managed care pricing models, rules and regulations. Keep current with all Medicare and Medicaid rules and regulations. Maintain strict confidentiality in accordance with HIPAA regulations and Company policy. Show less