Communicated all new or updated policy and procedure to providers.
Built and maintained relationships with users and providers to provide a high level of customer service.
Reviewed claims and contacted provider to recover payment.
Responded to electronic and direct inquiries from clients.
Resolved complaints and operational issues in collaboration with the Provider.
Identified and solved technical issues with a variety of diagnostic tools.
Followed up with clients to ensure optimal customer satisfaction.
Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
Interacted with providers and other medical professionals regarding billing and documentation policies, procedures and regulations.
Credentialing Coordinator09/2012 to 09/2013Computer Science Corporation CSCRaleigh, NC
Screened new provider and re-enrollment applications for providers within North Carolina and other states to ensure all required data is included and communicated deficiencies.
Assisted with communications to providers regarding status of applications and problem resolution.
Analyzed information submitted and details from verifications to identify any conflicting information.
Meticulously identified and rectified inconsistencies, deficiencies and discrepancies with licensures and certifications.
Customer Service Representative02/2010 to 09/2011Patient Financial ServicesRaleigh, NC
Communicated insurance payments and other issues to patients.
Obtained insurance information from patients to file claims accordingly.
Collected payments and set agreements on accounts with balances.
Offered discounts on accounts with balances after insurance payment.
Updated cycle codes in mainframe to assure accounts are not returned prematurely after agreement has been set.
Identified and resolved patient billing and payment issues.
Provider Enrollment Specialist06/2008 to 07/2012Saguaro Management & Accounting ServicesRaleigh, NC
Trouble shooted and resolved all Misys billing issues for rejected claims at twenty three locations throughout North Carolina to increase revenue by 15k-250k Conducted new hire orientation for physicians, licensed therapist & provisional providers.
Updated fee schedules for all insurance carriers to increase accuracy of payments.
Verified status of pending applications with insurance carriers.
Forwarded Medicaid provider numbers to appropriate personnel to obtain authorizations.
Attached providers to fees and insurance companies according to licensure.
Maintained a tracking system to ensure all provider licenses were current.
Thoroughly researched newly identified diagnoses and/or medical procedures to expand skills and knowledge.