resume_01-30-2017
TRANSCRIPT
Skills • Intermediate Proficiency in MS Excel, Outlook, WebEx
• 8 years data analysis and research experience
• 8 Years credentialing experience including Medicare and Commercial
• 6 months medical billing experience including billing/payments
• Fast typist (WPM: 75); Very Good 10-Key
• Strong organizational and interpersonal skills, Very patient, and detail oriented
Experience
Broad-Path Healthcare Solutions September 2013
to Present
Provider Data Analyst (UHC) January 2016 to present
• Solve moderately complex problems and conducts moderately
complex analyses
• Responsible for various activities related to the provider
network database: extracting data for various reports and
analyses
• Work with minimal guidance
• Performing comprehensive data and contract reconciliations
across platforms
Provider Enrollment Specialist September 2013-
December 2015
• Processing CMS Medicare Part B applications for JF & JE, paper
& web.
• Training assistant with Medicare Part B PE training on 855B
applications
• Side-by-Side mentoring/coaching to new hires
• Performed Quality Assurance (QA) audits on new hires
• Writing documentation of PE processes for training
Alorica (Call Center) – AT&T Wireless customer service rep May 2013-
September 2013
Unemployed due to relocating from Florida to Georgia December 2012 to
May 2013
Novitas Solutions, Inc. (CMS MAC contractor) July 2012 to Dec.
20, 2012
Technical Assistant
• Coaching/Mentoring/Auditing – Assist Medicare Provider Enrollment
Credentialist with questions pertaining to procedures, regulations, and in
processing CMS-855 applications.
First Coast Service Options, Inc.(CMS MAC contractor) October 2008 –
July 2012
Provider Enrollment Specialist
• Screen, validate and process sensitive information given by providers
• Conduct research, resolve problems and respond to telephone and written
inquiries from providers. Identify cases of suspected fraud
• Verify information and credentials supplied by the applicant
• Research and develop for additional information as needed to complete the
enrollment application. Act as customer service liaison to ensure that complex
issues are resolved timely
• Interact daily verbally or in writing with physicians, attorneys, and billing agents
• Create an enrollment record in the Provider Enrollment Chain Organization
System (PECOS)
FlagShipMD (Billing Agency) May 2008 to
October 2008
• Responsible for filing secondary insurance claims
• Interact daily verbally or in writing with physicians, patients/beneficiaries, and
insurance companies to attain payment and /or claim information
• Credentialing for physicians for enrollment in various insurance companies
Shands Hospital Orthopedics Clinic (Externship) March
&April 2008
• Trained on office systems
• CPT-Coding, ICD-9 Coding
• Computer processing, filing
Convergys Corporation (Call Center) October 1995 to
October 2007
Team Leader
• Supervisor of team customer service representatives for the Clairol client
• Various duties including monitoring, coaching/feedback, attendance issues,
performance reviews, call escalations, ensure all phone line are appropriately
staffed at all times.
Education
Everest University in Jacksonville, Florida – Medical Insurance Billing & Coding November 2007
to June 2008