Summary
Overview
Work History
Education
Skills
Skills
Affiliations
Certification
References
Timeline
Generic

ANGELICA M. ENGLISH

Louisville,KY

Summary

Results-driven individual with a solid track record in delivering quality work. Known for excellent communication and teamwork abilities, with a commitment to achieving company goals and delivering exceptional service. Passionate about continuous learning and professional development.

Overview

14
14
years of professional experience
1
1
Certification
1
1
year of post-secondary education

Work History

Provider Audit Representative 3

Humana Military
Louisville, KY
10.2024 - Current
  • Provides support to the Provider Data Management department to audit and update demographic information to the on-line provider directories.
  • Interacts with the provider representatives and facility personnel within the Humana Military’s provider network to obtain demographic information by telephone for the verification process.
  • Proficiency with internet navigation, Humana eVIPs system, Provider360 database, Microsoft office applications and Microsoft Outlook.

Credentialing Assistant 3

Humana Military
Louisville, KY
01.2017 - 10.2024
  • Provided support to the Credentialing department to process initial provider applications, verified submitted information such as education/degree verification, work history, state licenses, DEA and CDS certificates and criminal background checks.
  • Proficient with the internet, eVIPs system, Microsoft office applications, Outlook, CAQH system and AccuCheck System.
  • I interacted with provider representatives, providers and other credentialing specialists by telephone and email to request additional information and to answer credentialing inquiries.
  • Performed quality checks of the submitted provider applications to be certain all information received was complete and ready to start the credentialing process for Humana Military’s provider network of doctors, nurse practitioners, behavioral health specialists and other healthcare providers.

Registry Credentialing Specialist

Sharp Health Care Plans (Contract) - Alpine Staffing
San Diego, CA
08.2022 - 01.2023
  • Provided support to the Credentialing department to maintain the provider database, entered updated provider information, added new providers, terminated providers using the MD Staff system, CACTUS system and Sharepoint system.
  • Interacted with other departments to request additional information or other inquiries.

Provider Operations Coordinator

WellCare Health of Kentucky (Contract) – Healthcare Support Staffing
Louisville, KY
11.2016 - 12.2016
  • Provided support to Provider Operations department to update demographic information to start credentialing process for WellCare’s provider panel.
  • Utilized the Xcelys, Sales Force, and A&A Tracker system to verify provider information.

Contract Loader II – National Ancillary Contracts

Humana, Inc. – (Contract) – Lance Soft, Inc.
Louisville, KY
11.2015 - 06.2016
  • Provided support to the Ancillary Contractors to process requests from physicians and facilities “Request to Join” Humana provider network for Chiropractors, Physical, Speech, and Occupational Therapists, Skilled Nursing Facilities, Durable Medical Equipment, Ophthalmologist/Optometrist and Audiologist.
  • Utilized CCP2, SharePoint, CAS, PAAG (Provider-At-A-Glance) and Adobe EchoSign software system for “Request to Join”, verify existing provider contracts, locate provider demographic information and provider credentialing status.
  • Updated provider demographic information processed and tracked “Thanks But No Thanks” rejection letters.

Patient Advocate

Kentucky One Health – Conifer Health Solutions
Louisville, KY
11.2014 - 09.2015
  • Screened patients for insurance coverage.
  • Answered questions from patients.
  • Assisted patients with applying for insurance through the Kynect system and financial assistance through the hospital.
  • Entered and verified patient demographic information through the AS/400, Meditech, ACE and STAR systems.

Customer Service Representative

Kentucky One Health – Conifer Health Solutions (Corporate Office)
Louisville, KY
10.2013 - 11.2014
  • Answered all calls and questions from patients, insurance representatives, hospitals, physician’s office and attorneys.
  • Entered patient demographic information, verified all patent demographics and insurance.
  • Collected payments from patients, insurance companies and attorney offices and setting up payment arrangements on patient outstanding account balances.

Front Office Coordinator

University Neurologists (Contract) – Office Team Staffing
Louisville, KY
11.2012 - 05.2013
  • Provided dependable administrative support for the front office.
  • Answered all calls and questions from patients.
  • Completed check out and scheduling tasks.
  • Collected payments as needed in the office.
  • Verified insurance coverage.
  • Used the computer to enter patient data and process financial functions using Centricity Business and Allscripts EHR.

Medical Receptionist

Eye Specialist of Louisville
Louisville, KY
01.2011 - 02.2012
  • Provided a full range of administrative support for this ophthalmology practice of twelve physicians with a large patient pool.
  • Functioned as the point of contact, fielding and routing calls and interacted with patients to assess immediate needs.
  • Scheduled patient appointments collected financial and insurance data to ensure accurate and proper payment.
  • Used EMR to enter patient data using Centricity Business and researched pertinent medical and other information via the internet.
  • Prepared new and existing patient confidential files for the physicians and medical technicians.

Education

Associate of Applied Science - Healthcare Administration

Brown Mackie College
Louisville, KY
03.2011

Bachelor of Science - Communication

Walden University
11.2024 - Current

Skills

  • Microsoft Word
  • Microsoft Excel
  • Microsoft PowerPoint
  • Microsoft Outlook
  • Microsoft Access
  • Typing (55 to 60 WPM)
  • EVIPs
  • CAQH
  • CCP2
  • SharePoint
  • CAS
  • PAAG
  • Adobe EchoSign
  • Provider360
  • MD Staff
  • CACTUS
  • Database Management

Skills

Microsoft Word, Excel, PowerPoint, Outlook, Access, eVIPs, CAQH, CCP2, SharePoint, CAS, PAAG, Adobe EchoSign, Provider360, MD Staff, CACTUS, 55 to 60 WPM

Affiliations

  • Participates in the gospel singing group for the past 30 years, "Soulful Singing Sisters of St. Stephen's Christian Church.
  • Currently am a "Greeter" weekly for my church at Southeast Christian Church.

Certification

  • Obtained my Professional Academy for Healthcare Management (PAHM) certificate in 2019 through the Academy for Healthcare Management.
  • Graduated Magna cum Laude in 2011 with GPA 3.92

References

References available upon request.

Timeline

Bachelor of Science - Communication

Walden University
11.2024 - Current

Provider Audit Representative 3

Humana Military
10.2024 - Current

Registry Credentialing Specialist

Sharp Health Care Plans (Contract) - Alpine Staffing
08.2022 - 01.2023

Credentialing Assistant 3

Humana Military
01.2017 - 10.2024

Provider Operations Coordinator

WellCare Health of Kentucky (Contract) – Healthcare Support Staffing
11.2016 - 12.2016

Contract Loader II – National Ancillary Contracts

Humana, Inc. – (Contract) – Lance Soft, Inc.
11.2015 - 06.2016

Patient Advocate

Kentucky One Health – Conifer Health Solutions
11.2014 - 09.2015

Customer Service Representative

Kentucky One Health – Conifer Health Solutions (Corporate Office)
10.2013 - 11.2014

Front Office Coordinator

University Neurologists (Contract) – Office Team Staffing
11.2012 - 05.2013

Medical Receptionist

Eye Specialist of Louisville
01.2011 - 02.2012

Associate of Applied Science - Healthcare Administration

Brown Mackie College

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