Cleveland, Ohio, United States
Meticulous Credentialing Specialist who maintains highly sensitive provider information, meets time sensitive deadlines, and delivers exceptional customer service. Possess knowledge in credentialing and Revenue Cycle Operations. Focused, Organized, detail-oriented, motivated individual with three years’ experience, good communication skills looking to secure a new position. Core Competencies include: Credentialing • Excel • Word • SAP • New Facilities • W9’s • Client Relations • Practice Support • Scheduling • Claims • Malpractice • Terminations • NPI registrations • Intellicred • Practice View • Ariba • Change Helathcare • UPS • D Staff • CAQH • PECOS • Dentrix • Reimbursements • EFT enrollments • Initial billing • Dental Exchange • Denticon • DentalXchange • CAQH/ ADA • Availity Ariba • DocuFill •
Moved Credentialing successfully in house from a third-party vendor. Implemented a new Credentialing software. Processed provider credentialing information, including verification of data in accordance with policies and procedures, to support network development and credentialing processes. Maintained credentialing database while tracking all direct provider contract data. Maintained all dental license, DEA and malpractice for providers in database with updates to providers with expiration dates. Efficiently credentialed all initial and recredentialing providers in a timely fashion. Provide excellent customer service to providers, managers and teams. Progressively learning Fee Schedules and Claims Issues regarding OON or Denials. Learned provider set up within the practice management system and clearinghouse. • Successfully partnered with the recruiting department.
Prepared Facility Credentialing documents for all DeNovos, Acquisitions and Owner Changes. This spanned over 163 locations. Tracked 147C, Bill of Sales, completed updated W9s, NPPES system, along with closely working with the Legal Department. Partner with payers closely to be sure all changes/updates are made within the system for adequate updated facility par dates. Connect with the Credentialing Specialists to guide on provider credentialing submissions for adequate paperwork. Consistent reporting on status updates regarding facility changes. • Proficient in Adobe • Multi-Task in a high paced environment • Effectively partnered with the Legal Department to address issues timely while maintaining high productivity. Prepared credentialing documents for new providers joining the team. Supported 16 practices with over 87 providers and growing. Handled recredentialing, claims, tracking participation dates, and provider profile maintenance. Created and maintained provider profiles, tracked licensure expiration dates to ensure accurate provider credentials. Routinely followed up on participation with vendors, worked to insure precise, and accurate participation records. Updated W9’s, completed and tracked Recreds, maintained updated and mapped contracts for state specific insurers. Generated all required forms, coordinated onsite survey’s, compiled provider credentials, and submitted necessary PA owner signed documents to insurers. Tracked office approvals and provider participation with insurers to ensure full participation for new facilities on opening day. • Strong attention to detail. • Excellent verbal and communication skills. • Ability to adapt effectively.
Created and managed provider CAQH profiles. Supported over 100+ growing Nurse Practitioners. Processed and maintained provider PECOS Medicare accounts. Prepared and submitted Medicare reassignments, corrections, and processed rejections. Maintained location site information for Medicare PTAN numbers. Built Credentialing Status Report for tracking contracting needs per state and payors. Worked to create and implement more effective department processes. Researched and compiled a payor contact and requirements report to insure accurate credentialing procedures were adhered to according to individual payor needs. Routinely followed up with payors to maintain accurate participation information. Generated all outside payor contracts, followed up with providers for signatures in Adobe Sign, and submitted contracts along with supporting documentation for provider participation requirements. Built provider roster containing all provider credentialing information for payor spreadsheet submissions. Handled encrypting highly sensitive provider information to ensure provider privacy. Researched claim denials for participation issues. Updated provider in-house profile with required credentialing and licensing information. Worked to build MD Staff profiles for providers by entering all credentialing information. Created AD Hock query reports for monthly roster submissions. Lead training sessions with Licensing and Collections departments on how to use MD Staff software. Researched and approved potential new payors to work to obtain new in network contracts for the company. • Effectively managed high-volume emails and provider requests • Ability to multitask efficiently in a fast-paced environment • Fluent in all Microsoft office, Excel, MD Staff, and Adobe Sign programs
Compiled supply orders, employee payroll, and reconciled payroll discrepancies. Created customer quotes. Reviewed customer purchase orders against customer work orders to process for invoicing. Worked extensively with customers to correct purchase orders for invoicing to assure customer payments. Participated in monthly financial meetings, updated weekly tracking reports for unbilled and AR lists. Worked one on one with local union representatives to ensure all paperwork was documented correctly. Directed work order training classes, handled uniform ordering and tracking, and maintained employee union paper work. Created forms for tracking employee uniform returns to ensure accurate tracking for both the employees and the company. Assisted the HR representative with drug screenings, benefits explanations and direct deposit paperwork. Provided training for new administrators. Participated in new hire interviews. Maintained current employee contact information. Worked extensively on customer accounts receivables in order to collect over $500,000. Strong ability to handle sensitive customer and employee information. Successfully implemented payroll and invoicing procedures for a new and growing office. Ability to tackle a high volume account with many billing obstacles.