April Mitchell
East Amherst,NY
Summary
Results-driven Credentialing Coordinator with experience in ensuring compliance with regulations and standards related to provider credentialing. Skilled in documentation review, information verification, and schedule management. Demonstrated ability to maintain accurate provider information and coordinate the renewal of licenses and certifications. Excellent verbal and written communication skills. Proficient in COI malpractice, RFX and silversheet software, and payors websites.
Overview
9
9
years of professional experience
Work History
CREDENTIALING COORDINATOR
University of Buffalo neurosurgery
03.2023 - 11.2024
- Ensured compliance with applicable laws, regulations, policies, procedures and accreditation standards related to provider credentialing
- Drafted letters and forms to communicate changes or updates regarding the credentialing process to providers
- Prepared profiles and completed permanent files to facilitate review and approval
- Verified validity of licenses and certificates to meet regulations
- Completed credentialing and re-credentialing applications to process files and applications
- Assisted with onboarding new providers by verifying credentials according to established standards
- Maintained accurate documentation of all provider information including licensure status; privileges granted; reappointment and renewal dates; disciplinary action taken
- Coordinated and monitored the renewal of all provider licenses, certifications, memberships and delegations of authority
- Populated, updated and maintained credentialing software and filing systems
- Collected fees for licenses
INSURANCE AGENT
Highmark Health Insurance
05.2021 - 03.2023
- Built and maintained relationships with clients to support satisfaction
- Demonstrated excellent communication skills when discussing insurance policies with customers to ensure they were fully informed of their coverage options
- Developed strong customer service skills while working as an Insurance Agent, including problem resolution and conflict management
- Interpreted insurance policies and explained coverage to clients
- Contacted prospective and current clients via telephone to provide quote and policy information
- Understood customer requirements and tailored insurance plans to fit needs
- Calculated premiums and established payment method
- Handled customer complaints and inquiries in a courteous and efficient manner
- Developed strong customer relationships and loyalty through effective communication
- Responded to telephone inquiries and complaints following standard operating procedures
- Complied with corporate and regulatory policies regarding information confidentiality and privacy
- Performed data entry tasks accurately and in a timely manner
CLAIMS SPECIALIST/ TEMPORARY
Navient
01.2020 - 01.2021
- Investigated and analyzed requirements to improve timeliness of reports to customers
- Processed weekly claims daily and expertly handled as many as 20 calls with impeccable quality
- Reviewed documentation and accounts to gain full picture
- Supported efficient handling of complex claims and followed up on open, denied or suspended claims to complete required time lines
- Delivered quality customer service to assigned, insured and claimants throughout entire claims process
- Promoted agency products to customers in person, by telephone
- Reviewed incoming documentation for completeness prior to processing a claim
- Attached information to claim file
ADVANCED MEDICAL SUPPORT ASSISTANT
Charles George VA Medical Center
06.2018 - 12.2019
- Updated outdated patient information to maintain current records
- Retrieved patient files for doctors
- Scheduled approximately 20 appointments daily for Eye & Dental
- Relayed messages from patients to physicians about concerns, condition updates or refill requests to facilitate treatment
- Scheduled appointments for patients via phone and in person
MEDICAL ASSISTANT/ADMINISTRATIVE ASSISTANT
Kenton Family Care Primary / Kenmore Mercy Hospital
08.2015 - 06.2018
- Organized charts, documents and supplies to maintain team productivity
- Contacted pharmacies to submit and refill patients' prescriptions
- Secured patient information and maintained patient confidence by completing and safeguarding medical records
- Conducted insurance verification and pre-certification and preauthorization functions
- Followed principles of asepsis and infection control to meet patient safety guidelines
- Responded to patient callbacks and phone-in prescription refill requests
- Booked surgeries according to physician volume and maintained prompt turnaround times
- Scheduled follow-up appointments as designated by physician
- Checked physician orders and schedule availability to make accurate appointments for tests and surgical procedures
- Conveyed information to patients about arrival times and preoperative procedures
- Answered phone calls to provide assistance, information and medical personnel access
- Scheduled and confirmed patient appointments for diagnostic, surgical and consultation services
- Managed physician calendar, scheduling patient appointments and procedures
- Relayed messages from patients to physicians about concerns, condition updates or refill requests to facilitate treatment
- Interviewed and engaged patients to obtain medical history, chief complaints and vital signs
- Prepared treatment rooms for patients by cleaning surfaces and restocking supplies
- Educated patients about medications, procedures and physician's instructions
- Assessed, documented and monitored vital signs for patients within outpatient setting
- Cleaned and maintained medical equipment following procedures and standards
- Documented notes during patient visits
- Worked with operating facilities to schedule procedures on behalf of surgeons
- Gathered current medical information and reviewed histories to gather details for surgeons
- Performed EKG testing under the direction of a cardiologist or other specialist
- Prepared treatment rooms for patient examinations, kept rooms neat, and clean
- Efficiently managed patient scheduling and registration processes, ensuring accuracy of information and compliance HIPAA regulations
- Educated patient in person or by telephone on pre and postoperative care instructions
- Conducted preoperative phone calls with patients to verify insurance benefits and review instructions for arrival time, location and preparation requirements
- Assisted in coordinating post-surgical follow-up visits with patient
- Worked podiatry,GYN, family care and pediatrics.
Education
High School Diploma - undefined
Sweet Home Senior High School
Amherst, NYAssociate of Applied Science - undefined
Bryant And Stratton College
Getzville, NY05.2015
Skills
- Documentation Review
- Information Verification
- Customer Service
- Problem-Solving
- Data Entry
- New Policies Processing
- Verbal and Written Communication
- Policy and Procedure Explanations
- Decision Making
- Schedule Management
- Critical Thinking
- Excel Spreadsheets
- COI malpractice
- RFX and silversheet software
- Payors websites
Timeline
CREDENTIALING COORDINATOR
University of Buffalo neurosurgery
03.2023 - 11.2024
INSURANCE AGENT
Highmark Health Insurance
05.2021 - 03.2023
CLAIMS SPECIALIST/ TEMPORARY
Navient
01.2020 - 01.2021
ADVANCED MEDICAL SUPPORT ASSISTANT
Charles George VA Medical Center
06.2018 - 12.2019
MEDICAL ASSISTANT/ADMINISTRATIVE ASSISTANT
Kenton Family Care Primary / Kenmore Mercy Hospital
08.2015 - 06.2018
High School Diploma - undefined
Sweet Home Senior High School
Associate of Applied Science - undefined
Bryant And Stratton College
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