Rachel "Anna" Sowell
COLUMBUS,OH
Summary
As an Operations Resolution Specialist, I worked for five years in Provider Data Management (PDM) as a focused professional with success in problem-solving, creative solutions, and time management. I am accomplished in collecting supporting information, drafting and reporting comprehensive documentation, and resolving complex problems. I am known for reliability and adaptability, with swift capacity to learn and apply new skills. I am committed to leveraging these qualities to drive team success and contribute to organizational growth. I hold a Bachelor of Arts degree in Medieval and Renaissance Studies from The Ohio State University which is highly useful with research and out of the box thinking skills. I am also an independent scholar and have a passion for learning and sharing knowledge.
Overview
22
22
years of professional experience
1
1
Certification
Work History
Operations Resolution Specialist Provider Data Management
MediGold
09.2020 - Current
- Process and monitor up to 26 monthly delegated and direct provider rosters submitted in Excel format via submission through Microsoft Outlook.
- On-boarded new delegation accounts by working with Contracting, IT, and EDM departments to streamline reading of new spreadsheet into the automated system.
- Process and monitor two to six monthly facility rosters submitted in Excel format.
- Process automated Excel PDL reports from direct and delegated rosters to include manually entering line errors into Amisys provider system.
- Data Integrity audits: Duplicate affiliations, Duplicate provider #s, NPI deactivated via Quest Excel reports, Medicare Opt Out, Provider on Review, Termed provider audit, Directory audit, Pay class audit in Amisys, Attribution audits.
- Monitor and process provider data inquiries for claims, credentialing, and contracting statuses via AWD department call queue.
- Answer escalated requests from both internal and external parties on provider records via Outlook using Amisys, Google, NPPES, FileBound, Certify credentialing platform, and State verification sites.
- Update and maintain attribution data via Microsoft Word from Contracting Director on provider records for accurate risk assignment and distributing to appropriate departments for utilization.
- Special projects for data updates. Consistently meeting all deadlines for project completion and new process implementation.
- Process records via Unknown report from Claims Department to load OON providers for fall-out claims from Excel sheets in Teams platform.
- Problem solving through existing data file and internet research.
- Created SOPs for department processes.
- Training of new employees on the PDM processes and data monitoring.
- Organized and detail-oriented with a strong work ethic.
- Self-motivated, with a strong sense of personal responsibility.
- Participated in team projects, demonstrating an ability to work collaboratively and effectively.
- Skilled at working independently and collaboratively in a team environment.
- Versatile professional with strong problem-solving skills and history of adapting to diverse challenges. Applies innovative solutions and technical expertise to deliver exceptional results. Committed to streamlining processes and advancing organizational objectives.
Credentialing & Data Management
MediGold through Nesco Resources
03.2019 - 09.2020
- This position transitioned to a full-time remote (work from home) position in 2020. Department has since been folded under Contracting Director.
- Credentialing Process included initial provider, re-credentialing, delegation, and facility.
- Built SOPs for existing and new processes.
- Verification of documents submitted for committee approval.
- File audits.
- Verified provider data was current and compliant with CMS guidelines.
- Maintained information confidentiality per PHI and HIPAA guidelines.
- Trained new employees.
- Expansion state projects for newly covered areas.
- Problem Solving skills.
- Support for department Directors.
- Developed and maintained courteous and effective working relationships.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Learned and adapted quickly to new technology and software applications.
- Identified issues, analyzed information and provided solutions to problems.
- Proved successful working within tight deadlines and a fast-paced environment.
- Demonstrated strong organizational and time management skills while managing multiple projects.
Patient Coordinator
Dr. Kvitko & Associates
07.2015 - 12.2018
- Record and report maintenance
- Patient scheduling
- Provider scheduling to be concurrent with production goals
- Presenting treatment plans
- Researched and educated on insurance benefits
- Verified employee timecards in absence of practice manager
- Process claims, accounts receivable, collection accounts
- Administrative support for business owner and staff
Layout Director
Oak Leaves
12.2013 - 06.2015
- I served in a volunteer position as the Layout Director for the quarterly publication, 'Oak Leaves.' I was responsible for the formatting, layout design, and final edits before the printing of articles, artwork, and advertisements.
Bibliographer
Acorn Bookshop, Inc.
08.2011 - 06.2013
- Built records in database
- Creation of advertising materials
- Basic website updates using Dreamweaver
- Research of acquired materials
- Customer Service
- Administrative support for owner and staff
Library Associate (work Study)
Rare Books and Manuscripts Library, OSU
09.2010 - 09.2011
- Cataloged and processed new acquisitions in Pulp Fiction, LGBT, Irish Collection, Geological Maps, Scales, and Occult.
- Fulfilled individual and group requests from the library vault.
- Processed requests in Millenium for research.
- Record updating using Library of Congress subject headings.
- Assisted Patrons in locating research materials.
- Used OCLC and Illiad systems to research and request materials.
- Created marketing materials for collections.
- Assisted in production of RBMS Newsletter.
- Assisted in setup/breakdown of exhibitions and lectures using rare materials.
- Trained new students on Library Reading Room Procedures.
Library Associate (Work Study)
Ohio State University Music Library
06.2011 - 08.2011
- Coded materials within Music Library for building move.
- Marked shelves for incoming materials from move.
- Assisted patrons.
Product Engineering Technician
Thomasvillle Furniture
09.2003 - 10.2006
- Processed Bills of Material from Engineers using M204 system.
- Updated existing Bills of Material with new changes.
- Assigned UPC numbers to new items.
- Worked within SAP to track materials and orders.
- Processed sample orders for international shipping.
- Arranged shipping for samples to twice-yearly Furniture Shows.
- Assisted in creation of marketing materials and POP's for new items.
- Provided administrative support for executives and engineers including travel arrangements.
- Converted Bills of Material procedures from handwritten forms to Excel Spreadsheets.
Education
Bachelor of Arts (B.A.) - Medieval and Renaissance Studies
The Ohio State University
Columbus, OH01.2011
Laboratory -
Hill Museum & Manuscript Library
Minnesota01.2011
Skills
- Multitasking Abilities
- Time management abilities
- Effective communication
- Critical thinking
- Reliability and Adaptability
- Problem-solving aptitude
- Professionalism
- Creative solution development
- Teamwork
- Database management
- Microsoft Office - Excel, Word, Teams, Outlook, PowerPoint, Publisher
- Amisys, FileBound, Zenworks, Certify, Google search engine
Websites
Certification
University Teaching 101
Awards
- USG Grant
- Hilandar Scholastic Grant
Timeline
Operations Resolution Specialist Provider Data Management
MediGold
09.2020 - Current
Credentialing & Data Management
MediGold through Nesco Resources
03.2019 - 09.2020
Patient Coordinator
Dr. Kvitko & Associates
07.2015 - 12.2018
Layout Director
Oak Leaves
12.2013 - 06.2015
Bibliographer
Acorn Bookshop, Inc.
08.2011 - 06.2013
Library Associate (Work Study)
Ohio State University Music Library
06.2011 - 08.2011
Library Associate (work Study)
Rare Books and Manuscripts Library, OSU
09.2010 - 09.2011
Product Engineering Technician
Thomasvillle Furniture
09.2003 - 10.2006
Bachelor of Arts (B.A.) - Medieval and Renaissance Studies
The Ohio State University
Laboratory -
Hill Museum & Manuscript Library
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