Clarissa Sunico

•Reviewed healthcare provider requests for pre-credential with multiple states.

•Outreached to healthcare providers for missing documentation such as: professional license, malpractice insurance, DEA, contracts, curriculum vitae, malpractice insurance and other required information including signatures required by CIGNA for credentialing.

•Documented and communicate appropriate correspondence to matrix partners in contracting, provider service representatives and healthcare providers within the CIGNA database (ETQ’s & CPF/HCPM) while meeting a 20 a day TAT.

•Initiated and maintained effective channels of communication with providers and matrix partners.

•Generated CAQH(Council for Affordable Quality Healthcare) applications into system.

•Determined and applied knowledge of provider networks, HMO, PPO, OAP, fee-for-fee service, and consumer directed insurance products.

•Assisted with the identification of educational

opportunities/programs to improve overall services internally as well as to the provider network.

•Developed and maintain positive relationships with healthcare professionals within the network, resulting in quality service.

•Specific responsibilities include but are not limited to educating of the plan’s policies and procedures to healthcare professionals, resolving complaints and disputes, ensuring compliance with policies and procedures.

•Assisting offshore teams for IRS inquiry.

•Responsible for reviewing contracts signed by Health Care Professionals that needs to be processed by Contract Execution team.

• And other required information and signatures required by CIGNA for credentialing
• Documented and generated appropriate correspondence to matrix partners in contracting, provider service representatives and healthcare providers within CIGNA's database (ETQ’s & CPF/HCPM) while meeting a 20 a day TAT
• Initiated and maintained effective channels of communication with providers and matrix partners
• Generated CAQH (Council for Affordable Quality Healthcare) applications into our system
• Determined and applied knowledge of provider’s networks, HMO, PPO, OAP, fee-for- fee service, and consumer directed insurance products
• Assisted with the identification of educational opportunities/programs to improve overall services internally as well as to the provider network
• Developed and maintained positive relationships with healthcare professionals within a network, extending high quality service
• Specific responsibilities include but are not limited to explaining the plan’s policies and procedures to healthcare professionals, resolving complaints and disputes, ensuring compliance with policies and procedures
• Assisting offshore team for IRS inquiry
• Responsible for reviewing contracts signed by Health Care Professionals that needs to be processed by Contract Execution team
• Only individual passed Texas's audit for 100% quality, Managed billing collections of assigned medical patient accounts
• Balanced payments to accounts receivable ledger and aging reports
• Claims submitted through electronic or HCFA 1500
• Responsible for taking and processing customer orders and handled customer needs
• Reviewed prescriptions and authorizations to ensure accuracy of all billing requirements
• Processed eligibility requirements for each individual patient
• Communicated with doctors to acquire necessary documents for billing approval
• Prepared month end closing reports.

• Responsible for thoroughly checking vendor invoices for accuracy on extensions, sales taxes, freight, and discounts with references to purchase orders issued
• Analyzed agreements, contracts and board letters submitted by accounts payable with regards to correctness in determining accounts, timeliness of payments and divisional authorizations before check processing
• Data entry for rate analyses such as cost allocation, equipment, and overhead, all of which required an understanding of CAPS/FMIS reports
• Researched past year’s fiscal information through microfiche and past reports through system archive and retrieval.