Charity Harris
Summary
Highly skilled Provider Services Specialist with background in liaising between medical providers and insurance companies to ensure accurate billing practices. Proven ability in customer relations, problem-solving, and multitasking while maintaining professionalism and compassion. Strong record of enhancing efficiency through process improvement and policy enforcement. Previous work has led to smoother operations and improved provider satisfaction levels.
Overview
23
23
years of professional experience
Work History
Provider Services Specialist
CVS Healthcare
08.2024 - Current
- Facilitated provider enrollment and credentialing processes for healthcare professionals.
- Managed provider inquiries and resolved issues to ensure satisfaction.
- Collaborated with cross-functional teams to streamline communication processes.
- Analyzed provider data to maintain accurate records and compliance standards.
Provider Data Analyst
Firstsource Solutions (Anthem)
11.2021 - 08.2024
- Researched and resolved issues regarding integrity of data flow into databases.
- Identified and documented detailed business rules and use cases based on requirements analysis.
- Evaluated source documents to locate information needed for each data entry field.
- Verified the accuracy of computer system information by updating provider data.
- Outlined appropriate processes and procedures to fulfill and complete inquiries.
- Used Citrix, SPS & PDM to enter data over Timeframe, maintaining 98% accuracy.
Product Complaint Specialist (Contractor)
Pyramid Consulting (Pfizer)
Richmond
09.2019 - 03.2021
- Attended advanced training sessions and conferences to increase product knowledge and productivity.
- Minimized process lags through strategic sourcing and customer expectation management.
- Compiled data and reviewed information for accuracy prior to input.
- Monitored database updates and verified for correctness.
- Corrected data entry errors to prevent later issues such as duplication or data degradation.
- Outlined appropriate processes and procedures to fulfill and complete inquiries.
- Organized, sorted and checked input data against original documents.
- Executed data verification to detect errors.
- Documented customer interactions to capture data in processing system.
Purchasing Coordinator (Contractor)
VelociTel
Richmond
05.2018 - 07.2019
- Contacted each vendor and recorded information regarding price, availability, and quality of products.
- Collaborated with internal and external customers and managed all pricing and availability of all products.
- Created purchase orders and had each signed by production managers.
- Monitored all purchase requisitions and handled adjustments with vendors.
- Analyzed key aspects of business to evaluate factors driving results and summarized into excel reports.
Claims Analyst (Contractor)
VA Premier (VCU)
Glen Allen
04.2018 - 11.2018
- Evaluated all evidence with the ultimate goal of creating positive outcomes for clients' claims.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Verified medical insurance claims and determined fair amount for settlement.
- QA through HEDIS, NCQA
- Substantiated legitimate claims and denied unjustified claims.
- Reconciled data in direct collection system with the accounting system to address discrepancies.
- Evaluated insurance policies and analyzed damages to determine coverage.
- Documented all investigation activity and presented reports to management.
Pre-Financial Services Authorization Assistant (Contractor)
VCU Health System
Richmond
02.2017 - 01.2018
- Pre-Financial Services Maintained strict patient and physician confidentiality.
- Interaction with Authorization, providers, other medical professionals and patients.
- Researched newly VCU identified diagnoses and/or medical procedures.
- Identify and rectify inconsistencies, deficiencies and discrepancies in medical Richmond, VA documentation.
- QA through HEDIS, NCQA
- Worked with special insurance programs such as "Ryan White".
- Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
Insurance Authorization Specialist III
Bon Secours Richmond Health System
Richmond
06.2015 - 02.2017
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Assured the timely verification of insurance benefits prior to patient procedures or appointments.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Determined the appropriateness of payers to protect organization and minimize risk.
- Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
- Verified client information by analyzing existing evidence on file.
- Maintained a strong knowledge of basic medical terminology to better understand services and procedures.
- Processed an average of 120 patient authorizations each day and mailed documentation to clients.
Eligibility Analyst (Contractor)
Xerox Corporation
Richmond
01.2015 - 06.2015
- Reviewed applications for aid programs and determined which qualification criteria apply to individuals and families.
- Scheduled appointments with applicants to gather information and explain benefits processes.
- Followed state guidelines when reviewing applicant data to determine eligibility for Medicaid assistance.
- Determined applicant eligibility based on financial analysis and research.
Specialized Hearing Screen Medical Biller
MEDNAX Inc
Glen Allen
02.2010 - 01.2015
- Updated patient financial information to guarantee accuracy.
- Examined patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under their policies when applicable.
- Precisely completed appropriate claims paperwork, documentation and (Hearing Screen) system entry.
- Correctly coded and billed medical claims for various hospitals.
- Maintained strict patient and physician confidentiality.
- Interacted with providers and other medical professionals regarding billing and documentation policies, procedures and regulations.
- Accurately posted and sent out all medical claims.
- Submitted electronic-paper claims documentation for timely filing.
- Prepared billing correspondence and maintained database to organize billing information.
- Updated patient financial information to guarantee accuracy.
Insurance Verification Representative
HCA Healthcare Inc
Richmond
01.2007 - 01.2009
- Compliance and reimbursement accuracy.
- Maintained strict patient and physician confidentiality.
- Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing.
- Precisely evaluated and verified benefits and eligibility.
- Performed qualitative analysis of records to ensure accuracy, internal consistency and correlation of recorded data.
- Interacted with providers and others.
Provider Enrollment Specialist
First Health
Richmond
03.2003 - 01.2007
- Prepared and processed provider enrollments with Medicare and Medicaid in multiple states.
- Contacted insurance carriers to obtain information regarding denials.
- Secured competitive advantage in market by establishing exceptional network of care providers.
- Complete payer credentialing and re-credentialing applications for providers
- Responsible for follow through on payer credentialing/contracting progress for providers
Education
Associate of Arts - Healthcare Administration / Medical Records
University of Phoenix
Skills
- Data collection and analysis
- Multi-tasking
- Quality assurance
- Purchasing coordination
- Vendor relationships
- Conflict resolution
- Invoice processing
- Medical billing
- Medical Terminology
- Eligibility forms completion
- Invoice preparation
- Healthcare regulations
- Insurance claims analysis
- Insurance codes (ICD-10 and CPT-4)
- Data entry
- Detail Oriented
- Focused
- High Accuracy
- Microsoft Systems
- Oracle
- Citrix
- SPS
- PDM
Timeline
Provider Services Specialist
CVS Healthcare
08.2024 - Current
Provider Data Analyst
Firstsource Solutions (Anthem)
11.2021 - 08.2024
Product Complaint Specialist (Contractor)
Pyramid Consulting (Pfizer)
09.2019 - 03.2021
Purchasing Coordinator (Contractor)
VelociTel
05.2018 - 07.2019
Claims Analyst (Contractor)
VA Premier (VCU)
04.2018 - 11.2018
Pre-Financial Services Authorization Assistant (Contractor)
VCU Health System
02.2017 - 01.2018
Insurance Authorization Specialist III
Bon Secours Richmond Health System
06.2015 - 02.2017
Eligibility Analyst (Contractor)
Xerox Corporation
01.2015 - 06.2015
Specialized Hearing Screen Medical Biller
MEDNAX Inc
02.2010 - 01.2015
Insurance Verification Representative
HCA Healthcare Inc
01.2007 - 01.2009
Provider Enrollment Specialist
First Health
03.2003 - 01.2007
Associate of Arts - Healthcare Administration / Medical Records
University of Phoenix