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Skills

  • Business operations
  • Audit preparation
  • Staff training
  • Communications
  • Project management
  • Scheduling understanding
  • Process improvement
  • Lead prospecting
  • Supervision
  • Regulatory compliance

Work Experiences

  • Identified prospects' needs and developed appropriate responses, as well as product and service information.
  • Collaborated with cross-functional teams.
  • Met with current and potential customers to assess their needs and make recommendations for the best initiative solutions.
  • Collaborated with IT on transitioning provider file documentation.
  • Corrected discrepancies.
  • Created standardized protocols for data entry into the credentialing system, reducing processing errors across logistics by 17%.
  • Achieved 49% faster verification of provider eligibility.
  • Automated repetitive tasks using HubSpot, saving 7 man-hours per month and increasing file completion rates by 48%.
  • Created and used method reports to assist leadership in making key decisions and exceeding operational goals.
  • Conducted internal audits.

Summaries

  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Addressed incomplete provider file information.
  • Bringing 16 years of experience in this field.
  • Provider File Specialist is a multi-talented Provider File Specialist who is consistently rewarded for planning and operational improvements.
  • Adept at collaborating with cross-functional teams.
  • Aimed at continuous improvement.
  • Recognized for using ingenuity and creativity to meet and exceed sales, revenue, and profit targets.
  • Dedicated Sales Representative with a track record of identifying prospects and converting them into customers.
  • Professional with workflow optimization and stakeholder engagement expertise who is organized and resourceful.
  • Adept at training new team members, reducing training completion time by 6 months while enhancing team performance across key function areas.

Accomplishments

  • Led communication efforts between physician practices and insurance carriers to expedite the verification process, reducing processing time by 48%
  • Executed high-quality credentialing file audits, meeting or exceeding regulatory requirements, with a record of procedure.
  • Created user guides and training sessions on Adobe Creative Suite, reducing knowledge gaps within the provider file team by 83%.
  • Identified and resolved provider credentialing issues, reducing turnaround time by 58% and ensuring faster service authorizations.
  • Collaborated with team of 7 in the development of standard.
  • Collaborated on an initiative to de-duplicate provider records in the database, leading to cleaner data representation and a 84% improvement in system performance.
  • Liaised directly with physicians and insurance companies for issue resolution, reducing downtimes and accelerating approval rates by 75%.
  • Monitored and updated provider information, ensuring all records were current and aligned with relevant healthcare industry regulations.
  • Collaborated with insurance carriers to resolve complex credentialing issues, reducing rejection rates by 21%.
  • Contributed to the development of standard operating procedures (SOPs) for provider file management, leading to efficient, error-free operations.

Affiliations

  • Certified Professional in Healthcare Quality (CPHQ)
  • Lions Club
  • Society of Women Engineers
  • National Association of Credential Evaluation Services (NACES)
  • Project Management Institute
  • Credentialing and Schooling Evaluation Service the West Coast
  • Association of Professional Healthcare Administration (APHA)
  • International Council of Nurses
  • Society of Human Resource Management
  • American Society of Safety Professionals

Certifications

  • Healthcare IT Certified Professional (HITCP) - Harbor & Co.
  • Salesforce
  • Certified Provider Credentialing Specialist (CPCS) - Summit Group
  • Certified Provider Credentialing Specialist (CPCS) by the National Association Medical Staff Services - Cedar Works
  • Certified HIPAA Professional (CHP) - Cedar Works
  • Certified Healthcare Billing and Management Executive (CHBME) - Vantage
  • Certified Professional in Healthcare Quality (CPHQ) - Harbor & Co.
  • American Academy of Professional Coders (AAPC) Certificate - Brightline
  • Project Management Professional (PMP)
  • Lean Six Sigma Green Belt Certification – Harbor & Co.

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