Summary
Overview
Work History
Education
Skills
Timeline
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Barbara Thomas

Louisville,KY

Summary

Professional with background in provider services, skilled in managing provider networks and ensuring adherence to quality standards. Proven ability to enhance service delivery through effective onboarding and issue resolution.

Experienced with provider data management and regulatory compliance. Utilizes strong organizational and communication skills. Knowledge of problem-solving techniques.

Overview

27
27
years of professional experience

Work History

Provider Enrollment Coordinator

WellCare
02.2018 - 01.2024
  • Load providers to business/groups in management systems, ensuring accuracy and timeliness.
  • Adapted quickly to updates in enrollment software and systems, enhancing operational efficiency.
  • Provided routine administrative support, contributing to overall team productivity and effectiveness.
  • Established strong relationships with providers, fostering positive rapport and ensuring long-term partnerships.
  • Assisted in gathering and verifying provider documentation for enrollment processes.
  • Developed expertise in company-specific software tools for streamlined management of provider enrollments.
  • Assisted in reducing application processing time by efficiently reviewing and verifying provider credentials.
  • Supported data entry into provider management systems, ensuring accuracy and timeliness.
  • Reduced errors in provider information by conducting regular audits and updating records as needed.
  • Expedited resolution of discrepancies or missing information through diligent follow-ups with providers
  • Communicated effectively via telephone, email, fax or Mail.
  • Checked documentation for accuracy and validity on updated systems.
  • Verified client information by analyzing existing evidence on file.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.
  • Carried out administrative tasks by communicating with Providers, distributing mail, and scanning documents.
  • Learned compliance regulations related to provider credentialing and enrollment procedures.
  • 'Managed approximately 30 incoming calls, emails and faxes per day from customers.'

Network Provider Specialists

Anthem BC & BS
04.2012 - 10.2016
  • Managed provider database, ensuring accuracy of information and timely updates for operational effectiveness and improving workflow efficiency.
  • Managed providers while effectively handling multiple priorities and deadlines.
  • Maintained up-to-date knowledge as well as new system updates.
  • Educate providers on filling out PDF Form to make any changes, updates or how to load providers.
  • Creating new groups and loading new providers.
  • Conducted regular provider audits to maintain compliance with industry standards and regulations.
  • Updating/changing, and answering phone calls, emails, faxes or mailing letters out.
  • Performed various administrative tasks by filing, copying and faxing documents and Ordering Supplies for the stocking supply room.
  • Worked new providers, terming providers and groups.
  • Working PT, OT, SLP, Emergency ER's, Clinics and Hospitals.
  • Verifying providers information, licenses and credentials needed.
  • Led initiatives to improve operational workflows, enhancing efficiency in the provider onboarding process.
  • Provided exceptional support to providers, resulting in improved retention rates and overall satisfaction.

Senior Clerk

Anthem BC & BS
06.2006 - 04.2012
  • Oversaw daily clerical operations, ensuring accurate data entry and record management.
  • Developed and implemented efficient filing systems, improving document retrieval speed.
  • Trained junior clerks on office procedures and best practices, enhancing team performance.
  • Resolved complex administrative issues through analytical problem-solving and critical thinking skills.
  • Prescreen/Opinions
  • Pulling applications, rescans, mailing letters, returned mail, responsible for faxes.
  • Prioritized workload effectively managing multiple tasks at once maintaining focus under pressure while meeting deadlines consistently.
  • Cob's and EOB's
  • Answering phone calls for agents
  • Appeal Letters
  • Individual scanned box
  • Support for underwriters
  • Maintenance for all fax/copy machine
  • Loaded 100 Physicians every month

Claims and Billing Processor II

Anthem BC & BS
01.1997 - 06.2006
  • Processed Medicare, COB's, Subscriber Claims
  • Assisted Team Lead with training, researching missing batches, routing, prepping, retrieval and mailroom.
  • High production environment with established goals for production and quality.
  • Responsible for efficiency and accuracy of claims satisfaction.
  • Keyed claims from image using OCR and KFI database.
  • Pulled rejected claims from EDI RTP report.
  • HFCA and UB's Correspondence claims, Retrieved claims using ADHOC system and microfilm.
  • Processed high volumes of billing transactions accurately and efficiently.
  • Conducted audits on billing records to maintain accuracy and identify areas for process improvement.
  • Analyzed trends in billing data to inform strategic decisions and enhance overall financial reporting accuracy.
  • Consistently met deadlines for processing monthly invoices while maintaining high levels of accuracy.

Education

High School Diploma -

Southern High School
Louisville, KY
06.1996

Skills

  • HIPAA compliance
  • Claims processing
  • Insurance verification
  • Provider relations
  • Healthcare industry
  • Audit preparation
  • Excel
  • Printers/Fax Machines
  • Internet Explorer
  • Credentialing
  • Data entry skills

Timeline

Provider Enrollment Coordinator

WellCare
02.2018 - 01.2024

Network Provider Specialists

Anthem BC & BS
04.2012 - 10.2016

Senior Clerk

Anthem BC & BS
06.2006 - 04.2012

Claims and Billing Processor II

Anthem BC & BS
01.1997 - 06.2006

High School Diploma -

Southern High School

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