Troubleshoot medical insurance claims that are denied by multiple companies, responsible for over $285,000 in denied insurance claims being paid to clients in 2013 and 2014.
Designed and implemented Provider Credentialing Packet for execution of provider enrollment and hospital privileges, increasing productivity and ensuring provider participation in a timely manner.
Liaison between customer service representatives and government/commercial insurance departments regarding payment and provider information.
Initiate new client set up, including system updates, notification to insurance payors, hospital appointments, facility and provider credentialing. Assemble information to complete provider enrollment applications and ensure participation in government and commercial insurance plans. Hospital and insurance payor recredentialing for group practices and individual providers.
Track pending applications, contracts and agreements. Maintain physician information in credentialing software.
Perform administrative tasks including typing correspondence, filing, and data entry.
Maintain confidentiality of physician information, coordinate work with physician office staff.
Initial set up of computerized staffing system, including staffing software, excel spreadsheets resulting in consistent nurse to patient ratios.
Responsible for ensuring proper nurse staffing levels for all shifts for ICU, Med/Surg, and maintaining appropriate certified nurse’s aides staff levels.
Maintain nursing department staffing records including master schedule, cancellation list and attendance records, American Heart Association BLS and ACLS certifications.
Maintain employee skills test information, annual hospital updates and other educational competencies.
Maintain accuracy of nursing payroll for staff of 130.
Maintain temporary nursing staffing agency competencies, orientation and billing records.
On boarding for new nursing staff members and temporary employees.
Initiated Medicare and Medicaid provider enrollment applications, revalidations and provider changes for 200 plus group practice with high turnover.
Developed and maintained enrollment progress and provider number databases for department managers, developed new application process for new applicants.
Ensured Medicare /Medicaid compliance regulations were adhered to in regards to provider enrollment.
Appointed to Credentialing Task force, and Human Resources Classification Committee.
Verified that physician and allied health staff had the proper credentials to work in each medical discipline according to Medicare and Joint Commission guidelines.
Responsible for researching and verifying medical school transcripts, prior employment, personal and professional references and professional liability insurance history.
Detailed knowledge of Joint Commission, CMS, state and federal laws regarding accreditation standards
Maintained, reviewed and updated policies as needed.
Appointed to Human Resources Classification Committee.
Greeting office visitors, responded to patient complaints, and assisted director with staff issues.
Collaborated with director to design and implement report card style quality report for clinics, including tracking and reporting type of complaints per department.
General office duties, filing typing, answering phones, ordering and maintaining sufficient office supplies, and travel arrangements.
Tracked department budget and operating expenses, reported time and attendance in PeopleSoft.
Sorted incoming and outgoing mail.
Set up executive meetings, prepared agendas, taking minutes, ordered food and electronic equipment.
Presented Infection Control and Abuse/Neglect information for University New Employee Orientation, appointed to Human Resources Classification Committee.