Brittany Jackson
Katy,TX
Summary
Proven track record in enhancing compliance and operational efficiency at CedarGate Technologies LLC, leveraging expertise in Credentialing Oversight and a keen ability to manage data. Skilled in Regulatory Compliance and Database Maintenance, I've significantly improved provider enrollment processes. Adeptness in fostering improvements and a results-driven approach have consistently advanced organizational goals. Achievements include completing more than 60 healthcare provider applications each month with no critical errors.
Overview
8
8
years of professional experience
Work History
Credentialing Specialist
CedarGate Technologies LLC
12.2022 - 02.2024
- Completed 60+ application per month and excelled at KPI goals
- Assisted with managed care auditing processes and performed internal file audits
- Conducted periodic compliance audits and reviews to identify areas of improvement
- Maintained accurate files, records and credentialing documents in well-maintained databases using Symplr Provider (Cactus)
- Completed and won the record for the most applications processed without error in a quarter
- Wrote and designed training manuals and cheat sheets according to strict company guidelines and protocols.
Human Resources and Benefits Administrator
Genesis Community
04.2022 - 12.2022
- Identified workers with specific skill sets to recommend for promotions or raises, increasing internal hiring 15%
- Managed employee benefits program, working with vendors, providers, and staff to maintain strong portfolio of insurance and retirement options
- Managed continuous enrollment processes, as well as yearly enrollment periods
- Overhauled training programs and recommended improvements to management enhancing effectiveness
- Developed job-specific competencies and performance standards.
Credentialing Coordinator (Contract)
Pivot Physical Therapy
10.2021 - 02.2022
- Managed territories Delaware, West Virginia, Maryland independently during high onboarding and acquisition period
- Determined licensing eligibility by examining test results and comparing against established structures
- Conducted primary source verifications such as background checks and board certifications
- Enrolled providers and Medicaid, Medicare, and private insurance plans.
Service Coordinator (Contract)
NuMotion
05.2020 - 10.2020
- Resolved complex insurance verification and billing issues, successfully resolving an average of 20 claim denials per month
- Independently managed the schedules of 4 service technicians over 8 territories
- Coordinated and monitored service activities to confirm work met all requirements
- Resolved customer complaints and issues to drive satisfaction and loyalty
- Communicated with clients and service providers to provide updates on work progress
- Showcased exceptional organizational skills, managing multiple tasks, territories, and deadlines effectively.
Utilization Review Specialist (Contract)
Excellus BCBS
02.2019 - 02.2020
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services
- Devise or identify solutions for irregular requests and issues
- Performed prior authorization review of services requiring notification
- Submitted cases for criteria failures and helped facilitate resolutions and approvals
- Supervised and maintained all utilization review documentation through in house proprietary software
- Developed and updated policies and procedures, maintaining compliance with guidelines relating to HIPAA, benefits administration and general liability.
Credentialing Admin/ Patient Coordinator
Edith Grannum MD
08.2016 - 02.2019
- Studied processes, implemented cost reductions and developed reporting procedures to maintain administrative workflow
- Networked with industry professionals to exchange best practice knowledge and stay abreast of latest developments
- Compiled general ledger entries with 100% accuracy
- Submitted patient statements and medical billing to insurance companies
- Enrolled providers and Medicaid, Medicare, and private insurance plans.
Education
Medical Assistant Certificate -
Sanford Brown College
Tinley Park, United States05.2013
Skills
- Credentialing Oversight
- Application management
- Data Management
- Accreditation information management
- Regulatory Compliance
- Provider Enrollment
- Data Acquisition
- Database Maintenance
- Background Checks
- HIPAA Compliance
- Report Generation
- Symplr Provider (Cactus) expertise
- Provider enrollment
Additionalinformation
10/2020 - 11/2021, I worked several small term contract positions such as prior authorization representative, estimate pricing administrator, and medical biller and coder.
Timeline
Credentialing Specialist
CedarGate Technologies LLC
12.2022 - 02.2024
Human Resources and Benefits Administrator
Genesis Community
04.2022 - 12.2022
Credentialing Coordinator (Contract)
Pivot Physical Therapy
10.2021 - 02.2022
Service Coordinator (Contract)
NuMotion
05.2020 - 10.2020
Utilization Review Specialist (Contract)
Excellus BCBS
02.2019 - 02.2020
Credentialing Admin/ Patient Coordinator
Edith Grannum MD
08.2016 - 02.2019
Medical Assistant Certificate -
Sanford Brown College
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