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Click here or scroll down to respond to this candidateCandidate's Name
Home: PHONE NUMBER AVAILABLE Email: EMAIL AVAILABLEObjective: Detail-oriented and analytical professional with extensive experience in credentialing and regulatory compliance. Seeking to transition into an Analyst role within the federal government to leverage my skills in data analysis, project management, and policy evaluation to enhance program efficiency and effectiveness.Qualifications:Analytical Skills: Proficient in data analysis and problem-solving.Communication Skills: Strong verbal and written communication skillsAttention to Detail: Exceptional accuracy in documentation and reporting.Relationship Management: Skilled in building and maintaining relationships with clients, stakeholders, and team members.Problem-Solving: Ability to identify issues, develop solutions, and implement strategies to achieve objectives.Government Processes: Familiarity with government regulations, policies, and procedures.Collaboration: Effective at collaborating with cross-functional teams to achieve common goals.Data Analysis: Proficient in MS Office; Word, Excel, PowerPoint, and Adobe. Competent in analyzing data, generating reports, and making data-driven recommendations.Work Experience:Recredentialing Specialist - 01/2023- PresentDearborn Group Blue Cross Blue Shield, RemoteConducted detailed financial analyses of credentialing-related costs, identifying trends and potential areas for cost savings.Utilized data management systems to track financial metrics and prepared comprehensive financial reports for senior management, aiding in strategic financial decision-making.Managed the budget for the recredentialing department, ensuring all expenses were tracked and reported accurately.Ensured all financial transactions related to recredentialing activities adhered to regulatory standards and organizational policies.Conducted regular financial audits to maintain compliance and addressed any discrepancies promptly.Collaborated with finance, accounting, and other departments to ensure alignment on financial goals and reporting requirements.Presented financial findings and recommendations to stakeholders, utilizing clear and concise communication to facilitate informed decision-making.Developed and standardized financial documentation and procedures, enhancing transparency and accountability.Managed the end-to-end recredentialing process for numerous providers, ensuring timely and accurate completion.Coordinated with various departments, including legal, compliance, and human resources, to streamline workflows and resolve discrepancies.Developed and implemented a project plan that reduced recredentialing processing timeCredentialing Analyst 09/2021-01/2023Gain well (NJMMIS), Hybrid, NJConducted comprehensive analysis of applicant qualifications to ensure compliance with federal, state, and organizational regulations.Managed credentialing projects, coordinating with various departments to achieve timely and accurate outcomes.Developed and implemented procedures for document review and verification, to enhance operational efficiency.Communicated effectively with stakeholders, resolving discrepancies, and providing clear, actionable reports and recommendations.Utilized data management systems to track and report on credentialing processes, contributing to data-driven decision-making.Prepared detailed reports summarizing findings and recommendations for senior management, contributing to data-driven decision-making.Standardized financial documentation and procedures, increasing transparency, and improving accountability within the department.Conducted financial analysis review utilizing Microsoft Excel.Job Gap due to Covid 03/2020-09/2021Credentialing Analyst 01/2020-03/2020Internal Affairs, New JerseyScheduled and facilitated meetings, preparing agendas, and ensuring follow-up on action items.Developed and implemented administrative procedures to streamline workflows and improve efficiency.Managed and maintained credentialing databases, ensuring accurate and up-to-date records.Prepared and distributed comprehensive reports summarizing credentialing activities, metrics, and trends for senior management.Acted as a primary point of contact for providers and internal stakeholders regarding recredentialing inquiries and issues.Communicated effectively with various departments to resolve discrepancies and ensure alignment on credentialing requirements.Coordinated with IT and other departments to develop and maintain automated systems for tracking recredentialing statuses.Administrative Analyst 05/2017-01/2020Trinity Group (Pivot Point Counseling), RemoteGenerated detailed reports and dashboards to summarize credentialing activities, metrics, and trends for senior management.Conducted data analysis to identify inefficiencies and recommended actionable improvements.Analyzed financial data related to credentialing operations, identifying cost trends and providing optimization recommendations.Identified and implemented corrective actions to improve the quality and accuracy of credentialing processes.Stayed informed on regulatory changes and adapted processes to ensure ongoing compliance.Served as the primary liaison for providers and internal stakeholders regarding recredentialing issues and questions.Communicated effectively with various departments to resolve discrepancies and ensure alignment on credentialing requirements.Quality control identified credentialing issues that require additional investigation or evaluation.Input all the correct credentialing information documentation process provided by client to indicate next steps for actions in Epic.Utilized Excel Spreadsheets to adjust information as needed for clients to send out to key recipients daily.Utilized Adobe Acrobat as needed to scan and upload documents into relevant MS Excel SpreadsheetAdmin Coordinator 01/2017-05/2017United Health Group, Iselin, NJPerformed account receivables duties by reconciling invoices through reviewing and contacting consumers to ensure proper timely payments were made.Assisted in plans to cut cost and liabilities. This task required proper review of reports, detail oriented, and organization.Effectively communicated with customers regarding rental contracts, insurance coverages, and various deductible chargesDocumented all requests in appropriate systems and working with management to overcome any barriers to retrieving medical charts.Complied, and interpreted all verified financial data regarding patients billing.Approved and reviewed all invoices.Created weekly reports to delinquent invoice users.Administrative Assistant 01/2016-04/2016Horizon BlueCross Contract, Newark, NJScreened inquiries for referral to appropriate areas within the division or company.Provided the manager and/or other staff members with complete and timely background information on all telephone calls and correspondence.Created and maintained files and records (including electronic files).Supported the department by assisting with administrative and special projects as assigned by the manager.Prepared and typed routine and correspondence and memos via MS Word and Outlook.Tracked and maintained attendance records for regular submission via MS Excel Spreadsheets.Created, developed, and maintained databases related to departmental activities and special projects via MS Suite.Provided clerical support to departmental areas as needed.Worked all return mail do the research provider to get the correct information.Prepared the approved credentialing contracts to be mailed out to the providers.Reviewed and research different projects and reports.Document Specialist 02/2013-12/2015Horizon BlueCross Contract, Newark, NJPrinted and scanned score cards using Adobe Acrobat for all approve accounts.Kept the chart room organized at two different facilities and patients information confidential.Received incoming calls from agencies, clients, and hospital staff to identify information and taking appropriate actions needed.Prepared application packets.Checked Medicaid Eligibility Status.Scanned Medical Recorders into the hospital system via Adobe Acrobat.Requested bills and medical record.Submitted claims to vendors for final billing for Medicaid, Commercial Insurance, and Charity care program.Maintained and updated relevant MS Excel Spreadsheets to reflect current data for all accounts.Education & Training:Associate degree in insurance Coding & Billing Administrator from Dover Business College Clifton, NJ.Certificate of completion- Personal Medical Coder Course Medical Coding for Professionals School Linden, NJ.*References above upon request* |
