Credentialing Specialist

• Apr 2023 - Present

Credentialing Specialist

• Jul 2022 - Mar 2023

Administrative Assistant

• Sep 2020 - Aug 2022

● Checking patients in for scheduled appointments. ● Keeping track of medical records and charts. ● Scanning and uploading patient medical records into ScanChart-EMR System. ● Completing reports for missing documentation and signatures within patient records. ● Ordering supplies and maintaining general office standards. ● Use medical software to support all transactions. ● Maintain compliance with all regulatory and accrediting institutions. ● Monitor staff credentials and licenses. ● Participate in the development of internal credentialing processes. ● Keep records in-licenses, credentials, and insurance contracts. ● Release information to agencies and members of the public as required by law. ● Provides administrative support to ensure efficient operation of office. ● Answers phone calls, schedules meetings and supports visitors. ● Carries out administrative duties such as filing, typing, copying, binding, scanning, etc. ● Schedule and coordinate staff and other meetings. ● Collate and distribute mail. ● Prepare communications, such as memos, emails, invoices, reports, and other correspondence. ● Write and edit documents from letters to reports and instructional documents. ● Create and maintain filing systems, both physical filing and electronic. Show less

Claims Analyst

• Jun 2019 - Sep 2020

● Answering Health Plan phone lines and responding to Provider inquiries related to medical claims, benefits and Health Plan policies. ● Maintained all working relations with CCHP providers and members. ● Met the department’s production and quality goals. ● Ensured Provider’s were educated regarding medical claims determination, payments and the appeal process. ● Maintained appeal tracker by loading and attaching files in the appeals portal. ● Processed all appeals assigned prior to deadlines. ● Submitting the data regarding processing for the appeal through the portal. ● Work medical claims reports weekly to ensure medical claims are paid timely and accurately. ● Maintain relationship with Providers to ensure correct medical claim weekly payment, appeal determination and appropriate denial. Show less

Unit Supply Sergeant

• Jan 2018 - Sep 2020

● Manager of the supply office as the NCOIC and primary point of contact for all transactions and equipment. ● Completed monthly inventory computations by comparing them to physical counts of stock, and investigating discrepancies or adjusting errors, recording data manually or using a computer. ● Kept records on the use and/or damage of hazardous materials, inventory stock or equipment, reporting any damages to supervisors and checked quality of product prior to pulling order. ● Received, inspected, loaded, unloaded, stored, delivered and turned in organization and installation supplies and equipment orders using equipment such as forklifts, and other hand power tools. ● Awarded 2 Army Achievement medals. Show less

Claims Customer Service Representative

• Aug 2016 - Jun 2019

Provided excellent customer service by resolving and rectifying unsatisfactory client experiences. ● Review claims for providers and occasionally members regarding claim status. ● Provide verbal, printed and emailed requests for claims status to providers ● Gave excellent customer service by resolving and rectifying unsatisfactory client experiences. ● Review medical claims for providers and occasionally members regarding medical claim status. ● Assured all finding with verbal, printed and emailed requests for medical claims status to providers. ● Demonstrated awareness of and compliance with HIPAA and PHI regulations. ● In addition, provided assistance to the mailroom with data entry for claims by batching and entering. ● Wrote appeal letters to send to providers and members. ● Received over 20 awards for providing extraordinary customer and provider service. Show less

Unit Supply Specialist

• Jun 2012 - Dec 2017

● Manager of the supply office as the NCOIC and primary point of contact for all transactions and equipment. ● Completed monthly inventory computations by comparing them to physical counts of stock, and investigating discrepancies or adjusting errors, recording data manually or using a computer. ● Kept records on the use and/or damage of hazardous materials, inventory stock or equipment, reporting any damages to supervisors and checked quality of product prior to pulling order. ● Received, inspected, loaded, unloaded, stored, delivered and turned in organization and installation supplies and equipment orders using equipment such as forklifts, and other hand power tools. ● Awarded 2 Army Achievement medals. Show less

Member Services Associate

• Apr 2015 - Jan 2016

● Gave excellent customer service by resolving and rectifying unsatisfactory client experiences. ● Researched and followed-up on applicable membership, enrollment, billing, benefits and medical claim inquiries. ● Managed workload to ensure all processing times are met, and deliver exceptional service and build rapport with our Advisors and their staff. ● Gave excellent customer service by resolving and rectifying unsatisfactory client experiences. ● Researched and followed-up on applicable membership, enrollment, billing, benefits and medical claim inquiries. ● Managed workload to ensure all processing times are met, and deliver exceptional service and build rapport with our Advisors and their staff.

Member services Agent

• 2013 - 2015

renew prescription requests, clinical review requests, assist with prior authorizations for medications or insurance review, technical support, review claims for members and providers offices, etc. renew prescription requests, clinical review requests, assist with prior authorizations for medications or insurance review, technical support, review claims for members and providers offices, etc.