Experience

Elevance Health

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

• Medical Management Specialist II

  • Nov 2012 - Present



EMPIRE BLUE CROSS BLUE SHIELD HEALTH PLUS

• Medical Management Specialist ll ,MLTC/FIDA

  • Nov 2012 - Sep 2022

  • Work with provider relations team and claims department to resolve claim issues.• Perform resolutions of escalate claims inquire related to prior authorization.• Research and update member’s eligibility other insurance coverage.• Adjust provider information for claims payment.• Research the resolution for claims with nurse care manager to process payment. • Work with provider relations team and claims department to resolve claim issues.• Perform resolutions of escalate claims inquire related to prior authorization.• Research and update member’s eligibility other insurance coverage.• Adjust provider information for claims payment.• Research the resolution for claims with nurse care manager to process payment.



Elite Medical Billing and Collection

• Medical Collector and Credentialing Specialist

  • Jul 2012 - Nov 2012

  •Accurately apply payments to patient accounts•Implemented and monitored procedures and activities related to credentialing and re-credentialing of network providers.•Review provider files for appropriate documentation required for the credentialing process. •Coordinate credentialing and re-credentialing applications and conduct document research. •Collect and maintain files in relation to credentialing of network providers, including application, contracts, current physician licenses, DEA licenses, malpractice insurance, board certifications and other pertinent forms. •Received Managed Care and PPO provider applications and re-credentialing applications•Implemented and monitored procedures and activities related to credentialing and re-credentialing of network providers



BILLMED Management

• Medical Collector and Credentialing Specialist

  • Aug 2010 - Jul 2012

  •Responsible for the maintenance of the patient's documents and their addresses. •Processed patient's billing, statements, reimbursement claims, post transaction and data. •Deals with the queries and respond to them by telephone or by writing. •Responsible for the reports distribution, telephone and generation of the bills.•Collect and maintain files in relation to credentialing of network providers, including application, contracts, current physician licenses, DEA licenses, malpractice insurance, board certifications and other pertinent forms. •Review provider files for appropriate documentation required for the credentialing process. •Coordinate credentialing and re-credentialing applications and conduct document research.



Ultimate Billing

• Collection and Credentialing Specialist

  • Jun 2007 - Aug 2010

  • Improved revenue for most recent provider over 32% with same patient load• Ensure claims are entered and submitted with 48 hours of receipt• Accurately apply payments to patient accounts• Insure accuracy of insurance claims. Verify correct ICD-9 and CPT codes for a variety of specialties• Set up new patient accounts• Assign ICD-9 to physician’s diagnosis and insure correct level of service and various other CPT codes• Follow up on Insurance and patient aging. Re-submit insurance claims as necessary.• Followed up on credentialing applications• Initiated Medicare credentialing for 52 providers • Insure office practices are in compliance with HIPAA regulations