Summary
Overview
Work History
Education
Skills

Amber West

Credentialing/Enrollment Coordinator
Denver,CO

Summary

Dynamic and goal-driven healthcare professional with 21 years of diverse experience, I thrive in fast-paced environments where reliability and adaptability are essential. With a proven track record of excellent time management and problem-solving abilities, I excel at completing my responsibilities efficiently while embracing additional challenges to support my team. Passionate about continuous learning, I actively seek opportunities to expand my knowledge and skills, fueling personal success and the organization's growth.

Overview

21
21
years of professional experience
15
15

Years of Credentialing and Provider Enrollment experience.

12
12

Courses taken, minimum, to advance my career further

Work History

Credentialing/Enrollment Coordinator

Intermountain Health
Broomfield, CO
04.2016 - 06.2024
  • Obtained and uploaded all required enrollment documents for providers into the credentialing database
  • Managed CAQH account updates, password resets, attestations, and terminations
  • Completed and submitted initial enrollments and revalidation for providers with commercial and government payers
  • Completed and submitted facility and physician enrollments with Out-of-State Medicaid
  • Maintained all enrollment documents, licenses, board certifications, and demographic and specialty changes in credentialing databases
  • Assisted physicians with updating their CAQH, NPPES, and CMS accounts
  • Actively participated in provider onboarding and delegated credentialing meetings
  • Collaborated with Recruitment during the onboarding and off-boarding process of providers
  • Facilitated meetings for all contracted facilities and clinics as the primary contact for all enrollment issues
  • Generated Provider Enrollment Status reports, Payer Claim Holds reports, monthly new provider roster reports, and other Ad-hoc reports
  • Attended joint operating committee meetings for multiple payers as our department's Enrollment Issue Specialist.

Credentialing/Billing Specialist

Boulder Community Health
Boulder, CO
04.2015 - 03.2016
  • Conducted in-depth background investigations, research, and verification of application files
  • Skillfully prepared credentialing files for Health Medical Staff Committees
  • Completed initial payer enrollments and revalidations for providers
  • Preformed payer follow-up to confirm enrollment effective dates
  • Utilized CAQH and other credentialing databases for online verification, reporting, and document generation
  • Ensured compliance with regulatory bodies and medical staff bylaws, rules, and regulations

Patient Financial Representative

Exempla Healthcare
Denver, CO
07.2007 - 01.2013
  • Prepared claims to be submitted to insurance and verified coverage
  • Set denials on patient accounts
  • Corrected HCFA/UB92 claims such as codes or other errors as needed
  • Managed four different site locations as a Point of contact
  • Issued patient and insurance refunds
  • Data entry Follow up on claims submitted to insurance companies
  • Attended monthly site meetings
  • Researched and resolved complex billing issues with payers or other departments within the organization
  • Utilized various software applications including electronic medical records, practice management systems, claims processing systems.
  • Monitored aging reports regularly to identify outstanding balances that require attention.

Medicare Call Center Supervisor

Convergys
Denver, CO
06.2005 - 02.2007
  • Recruited, screened, and interviewed candidates
  • Evaluated employee performance metrics
  • Calculated, reviewed, and entered pay data to ensure accurate and timely payroll processing
  • Performed quarterly and annual evaluations of employees
  • Trained weekly CMS Up Training Courses
  • Implemented peer mentoring and performance coaching group
  • Conducted exit interviews
  • Provided guidance, training, coaching and mentoring to call center team members.
  • Monitored calls for quality assurance purposes.
  • Created incentives for employees who achieved high performance standards.

Education

Computer Science

Front Range Community College
01.2019

Medical Billing and Insurance Coding

Parks College
01.2004

Skills

  • Communication and Interpersonal Skills
  • Re-credentialing processes
  • Effective written and verbal communication
  • Documentation workflows
  • Validation of discrepancies
  • Strong organization
  • Proficient in Microsoft365, Teams, Cactus, EPIC, Echo OneApp, Verity Stream, CAQH, Pecos, NPPES, CMS
  • Meeting facilitator and acting moderator
  • Re-credentialing request follow-up
  • Medical terminology
  • Special projects
  • Process improvement techniques
  • Practitioner enrollment
  • Healthcare regulations
  • License verifications
  • Credentialing documentation
  • HIPAA compliance
  • Verbal communication
  • Running reports
  • Provider enrollment
  • Query tools
  • MS Excel
  • Dashboard creation
  • Reports generation

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Amber WestCredentialing/Enrollment Coordinator