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Click here or scroll down to respond to this candidateCandidate's Name
One Kathleen Court, Columbia, SC Street Address PHONE NUMBER AVAILABLE EMAIL AVAILABLESeasoned Medicare employee with Healthcare Insurance Industry experience seeking position of Provider Credentialing Specialist. 10+ years experience in Provider Enrollment Part A/B, DME and Finance departments for all medical specialties.E S S E N T I A L * S K I L L SSelf starter and quick learner. Work well in both independent work from home and team settings to ensure balanced workloads.Strong analytical and problem-solving skills. Good judgement skills.Ability to organize and prioritize job tasks and requirements. Multitasking proficiency. Time management.Excellent organization skills with the ability to prioritize assigned duties in an efficient amount of time and within deadlines.Ability to effectively perform in a multi-task work environment. Demonstrated ability to multitask with several providers at one time while submitting completed packages timely and accuratelyStrong communication and interpersonal skills.Ability to effectively use oral and written communication skills with clinicians, external agencies and management in a courteous and professional manner.Quickly adapt to changing and challenging environment.Knowledge and skills in using personal computers (Windows) with a strong emphasis on Microsoft Office Programs- Outlook, Word, Excel and Adobe Acrobat. PECOS, APEX, and MCSAbility to maintain patience and composure in difficult situations.High level of attention to detail.Thorough understanding and knowledge of enrollment-related guideline. Keep current changes initiated by CMS.P R O F E S S I O N A L E X P E R I E N C EProvider Credentialing Support II, Jurisdiction J5, IN, MI, WPS Health 2/2023 12/23Conducted thorough credentialing and recredentialing processes, including verifications of education, training, licenses, and certifications to ensure providers meet standards for all specialties.Reached out to providers to as needed to obtain missing documentation or clarity; answer any questions or concerns.Reconcile membership reports as required by CMS.Attended and successfully completed the continued trainings scheduled by the client and employer. Regular attendance and participation in team meetings and/or conference calls as scheduled.Established and maintained an appropriate level of communication with management to address issues and concerns and take preventive measures that ensure case accuracy and qualityParticipated in projects as assigned by managementMaintained accurate and up-to-date records in credentialing databases, ensuring compliance with standards.Final review of application forms prior to submission. Made sure documents are completed and submitted within set deadlines.Maintain consistent contact with healthcare providers to ensure that expectations are clear and requirements are completed in a timely manner. Gathered necessary documentation, resolved discrepancies, and facilitated credentialing process to completion.Tracks license, DEA, and professional liability expiration are for client providers.Demonstrated ability to work high load of providers at one time while submitting completed packages timely and accurately.Provider Enrollment Analyst, Jurisdiction JM, Palmetto GBA 2/ 2019 10/ 2022Researched and controlled incoming applications and correspondence to ensure work is properly categorized. Various applications for 855B, 855I for initial, reassignments, and reactivations.Maintained accurate and up-to-date provider data in accordance with industry standards and regulation.Reviewed and verified provider credentials, including education, licensure, and insurance information.Communicated with internal and external stakeholders to gather necessary information for enrollment and credentialing.Collaborated with cross-functional teams to ensure timely and accurate completion of enrollment and credentialing tasks.Monitored and tracked enrollment and credentialing applications to ensure timely completion.Stayed informed of changes in industry regulations and standards related to provider enrollment and credentialing.Identified and addressed any issues or discrepancies in provider enrollment and credentialingPrepared and maintained documentation and reports related to provider enrollment and credentialing processes.Provided excellent customer service to providers and internal teams regarding enrollment and credentialing inquiries; providing guidance and support as needed.Collaborated with leadership to identify areas for process improvement and implement solutions.Maintained confidentiality and adhere to HIPAA regulations in all aspects of the job.Performed other misc. special projects needed by management.Entered data into internal document management and workflow systems and maintained integrity.Created mail notification letters for application status.Provider Enrollment Analyst, National Supplier Clearinghouse DME, Palmetto GBA, Kelly Services6/2016 9/ 2018Researched and analyzed all Medicare National Provider Enrollment applications for DME. Closed and approved within department measures with little or no overtime. Updated information into database.Determined acceptability of applications and Provider file integrity. Ensured that suppliers are compliant with established standards and guidelines. Investigated/minimized potential issues.Authenticated required certificates and licensure required for compliance, reviewing validity per state websites and departmental sources.Articulated clear solutions to internal/external inquiries by correspondence and telephone. Assisted on Customer Services line. Educated Providers by listening to specific concerns and explaining enrollment process. Contributed to process improvements by coaching coworkers with computer technical skills.E D U C A T I O NUniversity of South Carolina : Bachelor of Science, Business Administration |
