Alesia Stone
Bossier City,LA
Summary
Dynamic Credentialing Specialist with proven expertise at WellPoint, adept in HIPAA compliance and provider enrollment. Recognized for enhancing operational efficiency through meticulous audits and effective data management. Committed to delivering exceptional service, leveraging strong communication skills to resolve complex issues and improve client satisfaction.
Overview
13
13
years of professional experience
Work History
Credentialing Specialist
WellPoint, Anthem Blue Cross
04.2016 - Current
- Collaborated with healthcare providers to gather necessary information for accurate credentialing decisions.
- Executed credentialing tasks for numerous providers concurrently, maintaining effective management of priorities.
- Conducted audits of provider files, ensuring all necessary documents were up-to-date and compliant with regulatory requirements.
- Enrolled providers and Medicaid, Medicare, and private insurance plans.
Claim Specialist
Avadyne Health
04.2014 - 04.2016
- Reviewed and maintained accurate claim files, ensuring all necessary documentation was in place for future reference.
- Maintained compliance with industry regulations by staying up-to-date on changes in policies and procedures, ensuring proper handling of sensitive information.
- Conducted thorough investigations into insurance claims to determine coverage eligibility and appropriate compensation amounts.
- Enhanced customer satisfaction with prompt and accurate claim resolutions, resulting in positive feedback and increased client retention.
Member Service Representative
Maximus Health Services/ Medicaid
01.2012 - 04.2014
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Provided exceptional service through active listening, understanding member needs, and offering appropriate solutions.
- Enhanced customer satisfaction by efficiently addressing and resolving inquiries and concerns.
- Maintained high-quality service by adhering to company policies and standards in all member interactions.
Education
Graduate Certificate -
Parkway High School
Bossier City, LA05.1982
Skills
- HIPAA compliance
- Audit preparation
- Provider enrollment
- Data management
Timeline
Credentialing Specialist
WellPoint, Anthem Blue Cross
04.2016 - Current
Claim Specialist
Avadyne Health
04.2014 - 04.2016
Member Service Representative
Maximus Health Services/ Medicaid
01.2012 - 04.2014
Graduate Certificate -
Parkway High School
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