Charma Green
Modesto,CA
Summary
Experienced professional in Medicare provider enrollment and commercial insurance credentialing. Specializes in enrollment evaluation and team supervision, ensuring compliance and accuracy. Skilled in quality assurance and primary source verification, leveraging Excel macros to improve operational efficiency and effectively resolve complex issues.
Overview
23
23
years of professional experience
Work History
Intake, Demographic Analyst, Bidirectional Analyst, Trainer & Peer Reviewer
United Healthcare
01.2019 - 06.2023
- Trained offshore employees in intake and demo analyst processes, enhancing team capabilities.
- Reviewed rosters from managers for accuracy and completeness of required 33 elements.
- Clarified missing elements with roster managers and followed up to ensure timely resolution.
- Prepared reviewed rosters for upload into specialized system, ensuring compliance with standards.
- Conducted analysis of special reports, validating data against updated files.
- Utilized Excel macros to compare rosters with provider validations, identifying discrepancies.
- Verified licensure and certifications to ensure compliance with regulatory standards.
- Communicated with external agencies to resolve issues related to provider credentials.
- Ensured timely completion of credentialing processes by providing guidance to providers on required documentation.
- Reviewed and processed credentialing applications, ensuring accuracy and compliance with accreditation standards.
- Performed primary source verifications such as criminal histories, licenses and board certifications.
Medicare Provider Enrollment Analyst
Jacobson Group/Palmetto GBA
06.2018 - 01.2019
- Analyzed provider data to ensure accuracy and completeness in enrollment applications.
- Conducted provider enrollment evaluations for compliance with regulatory requirements.
- Managed communication with providers to resolve enrollment inquiries and issues.
- Monitored changes in regulations impacting provider enrollment procedures consistently.
- Utilized electronic systems to maintain accurate records of enrolled providers efficiently.
- Provided technical assistance to providers regarding the completion of enrollment forms and supporting documentation.
- Identified potential fraud or abuse cases involving provider enrollments and reported findings accordingly.
- Assisted with the development of policies related to the Provider Enrollment process.
- Responded promptly to inquiries from providers or external agencies concerning their applications or other related matters.
Team Lead / Demo Analyst / Research Representative / Quality Analyst / Subject Matter Expert / Credentialing Representative
BroadPath Healthcare Solutions
Tucson, USA
12.2015 - 06.2018
- Assisted in supervising 28 team members
- Tracked employee attendance records to ensure accurate reporting and compliance with company policies.
- Compiled and submitted reports to client, addressing inquiries from client employees and participating in meetings to ensure clarity and alignment.
- Processed peer reviews for the client’s employees.
- Analyzed hundreds of applications monthly completed by Credentialing Representatives, ensuring accurate usage of systems and resources for application processing.
- Advised the reps of any errors that were found and assisted them with any questions.
- Answered daily questions from reps and supervisors regarding processing practices.
- Met weekly with client’s quality team to discuss questions we had and to review errors they had found.
- Led WebEx meetings with the supervisors for the Credentialing Reps to discuss new processes, changes to current processes and answer questions.
- Analyzed peer reviews and assisted in compiling a report for the project manager.
- While continuing to work as a credentialing representative, worked as a Subject Matter Expert.
- Provided support to coworkers by answering questions and offering guidance on processes and procedures. with questions via email and Jabber.
- Conducted research on complex provider applications to facilitate accurate assessments and processing. that were difficult to assess or had different scenarios than usual.
- Became knowledgeable with contracts, market numbers and determining which states and lines of business the provider was initially credentialed in.
- Became knowledgeable with the client’s tools and resources to assist co-workers.
- Developed learning tools including PowerPoint presentations, checklists, and training compilations to enhance onboarding and support for new team members.
- Verified providers’ re=credentialing profiles in CVOne which has been verified by Aperture.
- Verified that all pieces of information necessary for re=credentialing were current and still effective.
- Verified that the license, DEA and Board Certification were all still effective and that the Aperture verification day was still within 180 days.
- Verified that the hospital submitted was participating in the insurance plans and that the staff category met criteria.
- Verified that there were no flags in the systems and if there were, reviewed all malpractice reported to determine if the application could be sent to be approved or if it had to be reviewed by a medical director.
- Updated the software program to update the providers’ permanent electronic record.
Medicare Provider Enrollment Analyst
National Government Services
Denison, USA
01.2013 - 01.2015
- Conducted provider enrollment evaluations for compliance with regulatory requirements.
- Analyzed provider data to ensure accuracy and completeness in enrollment applications.
- Managed communication with providers to resolve enrollment inquiries and issues.
- Collaborated with cross-functional teams to streamline enrollment processes effectively.
- Provided technical assistance to providers regarding the completion of enrollment forms and supporting documentation.
- Investigated any errors or discrepancies in application documents in order to resolve them quickly.
- Utilized electronic systems to maintain accurate records of enrolled providers efficiently.
- Developed documentation for provider onboarding procedures and best practices.
- Created detailed reports summarizing enrollment trends, performance metrics, and areas for improvement.
Medicare Provider Enrollment Analyst
Trailblazer Health Enterprises
Denison, USA
01.2009 - 12.2012
- Analyzed provider data to ensure accuracy and completeness in enrollment applications.
- Conducted provider enrollment evaluations for compliance with regulatory requirements.
- Managed communication with providers to resolve enrollment inquiries and issues.
- Investigated any errors or discrepancies in application documents in order to resolve them quickly.
- Utilized electronic systems to maintain accurate records of enrolled providers efficiently.
Project Assistant
Pate Transportation Partners
Sherman, USA
01.2008 - 01.2009
- Coordinated project timelines and schedules for transportation initiatives.
- Assisted Project Manager in preparing project plans, schedules, and budgets.
- Assisted in developing project documentation and reports for management review.
- Organized logistics for meetings and events related to transportation projects.
- Managed project files and maintained organized records for easy access.
- Performed research related to projects as requested by the Project Manager.
- Developed processes and procedures to ensure efficient workflow of projects.
Office Manager
Red Leaf Capital
Denison, USA
01.2006 - 01.2008
- Managed office operations and ensured efficient workflow for Red Leaf Capital.
- Coordinated executive and team schedules to ensure seamless meeting logistics.
- Managed front desk operations including greeting visitors, answering questions or directing them to appropriate personnel.
- Oversaw office supply inventory and facilitated timely procurement.
- Maintained office equipment and facilitated repairs to minimize downtime.
- Developed and implemented administrative policies that streamlined workflow.
- Assisted in budget preparation and tracked office expenditures effectively.
- Maintained filing system for records, correspondence and other documents.
- Tracked invoices and payments to ensure accuracy of accounts receivable and payable information.
Workers’ Comp Claims Adjuster
Tuell & Associates
Livingston, USA
01.2003 - 01.2005
- Provided temporary support to ensure project continuity.
- Reviewed, evaluated and adjusted claims to promote fair and prompt settlement.
- Investigated claims by interviewing claimants and witnesses effectively.
- Reviewed medical records, police reports and other documents related to claim investigations.
- Documented claims findings in detail using company databases consistently.
- Maintained accurate documentation of all claim activity within designated system.
- Analyzed facts of loss including photographs, diagrams and other evidence to identify potential sources of recovery.
Claims Assistant & Examiner
Cambridge Integrated Services, Inc.
Modesto, USA
01.2000 - 01.2003
- Processed claims documentation for accuracy and compliance with company policies.
- Coordinated with adjusters to gather necessary information for claim resolution.
- Reviewed files to ensure all required documents were submitted timely.
- Investigated and resolved discrepancies in claims data entries.
- Maintained organized records of all claims and related correspondence.
- Supported team efforts by providing updates on claim progress and challenges.
- Answered inquiries from customers regarding their individual claims status.
- Managed incoming mail consisting of new applications and and or additional documentation required for existing open claims files.
Education
Intake Analyst / Demo Analyst / Bi-Directional Review -
United Healthcare
Team Lead / Demo Analyst / Research Representative / Quality Analyst / Subject Matter Expert / Credentialing Representative -
BroadPath Healthcare Solutions for United Healthcare
Medicare Provider Enrollment Specialist -
Workers’ Compensation Adjuster/Assistant -
Office Management/Executive/Secretarial -
Skills
- Enrollment analysis
- Credentialing
- Source verification
- Data analysis
- Quality control
- Remote collaboration
- Microsoft Office
- Time management
Timeline
Intake, Demographic Analyst, Bidirectional Analyst, Trainer & Peer Reviewer
United Healthcare
01.2019 - 06.2023
Medicare Provider Enrollment Analyst
Jacobson Group/Palmetto GBA
06.2018 - 01.2019
Team Lead / Demo Analyst / Research Representative / Quality Analyst / Subject Matter Expert / Credentialing Representative
BroadPath Healthcare Solutions
12.2015 - 06.2018
Medicare Provider Enrollment Analyst
National Government Services
01.2013 - 01.2015
Medicare Provider Enrollment Analyst
Trailblazer Health Enterprises
01.2009 - 12.2012
Project Assistant
Pate Transportation Partners
01.2008 - 01.2009
Office Manager
Red Leaf Capital
01.2006 - 01.2008
Workers’ Comp Claims Adjuster
Tuell & Associates
01.2003 - 01.2005
Claims Assistant & Examiner
Cambridge Integrated Services, Inc.
01.2000 - 01.2003
Intake Analyst / Demo Analyst / Bi-Directional Review -
United Healthcare
Team Lead / Demo Analyst / Research Representative / Quality Analyst / Subject Matter Expert / Credentialing Representative -
BroadPath Healthcare Solutions for United Healthcare