Dana Ward
Kent City,MI
Summary
Results-oriented professional with strong analytical abilities and a positive, upbeat attitude. Demonstrated knowledge of compliance regulations and healthcare industry standards. Expertise in data management and meticulous attention to detail. Committed to accurate credentialing processes that enhance organizational efficiency and maintain regulatory compliance. Skilled in conducting thorough application reviews and primary source verifications. Exceptional relationship-building, problem-solving, and communication skills contribute to successful outcomes.
Overview
12
12
years of professional experience
Work History
Credentialing Analyst II
Priority Health
05.2021 - Current
- Ensuring all necessary licensure and credentials are verified and updated which may include, but is not limited to, contacting licensing boards, reviewing license applications, obtaining education information and/or reviewing references
- Review of application to verify applicant meets all licensing and credentialing requirements
- Assess physician practice to ensure he/she is practicing within the state and federal regulations
- Maintain database which includes entering information, tracking licensing, compliance with federal standards, and completion of necessary training
- Reviewing and updating information in FACETS and eVIPS to ensure all information is accurate, making corrections and updates, as necessary
- Created and managed operational databases to store and track data and maintain accurate information.
- Collaborated with medical staff to gather necessary documentation for timely processing of provider applications.
- Assisted in maintaining an updated database of credentialed providers, allowing for quick access to essential information when needed by senior management or other departments within the organization.
- Contributed to a positive working environment by collaborating with team members and sharing expertise on credentialing processes.
- Ensured compliance with state regulations and accreditation standards by conducting thorough audits of credentials files.
- Completed comprehensive background checks, ensuring all candidates met company standards for quality care provision.
- Reduced processing time significantly by identifying areas for improvement in workflow processes.
- Expedited the onboarding process for new providers by accurately verifying their education, training, experience, certifications, and licenses within strict timelines.
- Managed strict deadlines effectively, prioritizing tasks and efficiently allocating resources to ensure optimal productivity.
- Successfully resolved complex issues regarding licensing discrepancies or other concerns involving provider qualifications.
Provider Reimbursement Analyst II
Priority Health
08.2017 - 05.2021
- Review of negotiated contracts and financial information to ensure correct reimbursement
- Use of data analysis and business practices to determine correct configuration for claims payment systems
- Extensive knowledge of facility and physician reimbursement methodologies
- Investigate and determine root cause of provider set up, contracts, and fee schedules
- Work collaboratively with other departments to ensure that issues with provider set up, contracts, and/or fee schedules are resolved in a timely manner
- Able to articulate payment and standard reimbursement methodologies to others and advise of appropriate billing procedures
- Reviews various websites to ensure information related to billing, pricing, and claims procedures is accurate and up to date
- Able to extract and utilize data for reporting purposes
- Liaison for internal and external customers
- Consistently within Service Level Agreement (SLA) standards and well above required productivity standards
- Assists other staff and departments as needed to be within SLA compliance
Regional Billing Supervisor
spectrum health systems
06.2015 - 08.2017
- Supervision of daily activities and workflow for the Medicare, Medicaid and Commercial (RHC) teams
- Monitored accounts to ensure timely and accurate payments
- Used root cause analysis to determine claim denials and/or system(s) issues
- Upheld and reinforced insurance and federal compliance laws and regulations
- Worked closely with management to ensure sound fiscal and business performance objectives were consistently met
- Identified and implemented process and system improvements
- Monitored and submitted payroll
- Audited staff weekly to ensure quality and productivity standards were met
- Interviewed, hired, and trained staff
- Management of staff schedules to ensure optimum coverage of workflows
- Monthly auditing and reporting to management to ensure minimization of bad debt
- Developed comprehensive training materials for new hires to ensure a smooth onboarding process and rapid acclimation to company systems and procedures.
- Created detailed reports for management reflecting key financial indicators such as receivables aging analysis, uncollected revenues breakdowns, write-offs statistics, among others contributing valuable insights into the department''s strengths and weaknesses.
- Improved billing accuracy by implementing systematic audits and updating procedural manuals.
Physician Revenue Cycle Supervisor
Mercy health
10.2014 - 06.2015
- Supervision of daily activities and workflow for the Medicare, Medicaid, and Commercial teams
- Collaborated with providers and insurance companies to determine billing and documentation policies and ensure compliance
- Resolved EDI, software, and hardware issues via communication with vendors, clearinghouses, and IT professionals
- Monitored completed accounts to ensure timely and accurate payments
- Used root cause analysis to determine claim denials and/or system(s) issues
- Identified and implemented process and system improvements
- Developed training procedures for staff
- Developed quality and productivity standards for staff
- Audited staff weekly to ensure quality and productivity standards were met
- Interviewed, hired, and trained staff
- Monitored and submitted payroll
Provider Enrollment Analyst II
Priority Health
05.2013 - 10.2014
- Loading agreements
- Loading providers
- Review of provider contracts
- Maintained strict confidentiality standards, ensuring sensitive provider data was handled with the utmost care and discretion.
- Optimized the use of department resources by regularly evaluating processes and suggesting improvements where needed.
- Upheld a high level of customer service while interacting with providers, fostering trust and confidence in our organization''s capabilities.
- Ensured timely completion of enrollment applications by closely monitoring deadlines and prioritizing tasks accordingly.
- Effectively managed multiple priorities, successfully meeting tight deadlines while maintaining high-quality work standards.
- Verified client information by analyzing existing evidence on file.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
Education
Bachelor - Health Services Administration
Baker College
Muskegon, MIMedical Assistant Diploma -
Davenport University
Grand Rapids, MI08-2010
Skills
- Leadership
- Project Management
- Team Management
- EVips
- Facets
- Lens
- Onbase
- Business Objects
- Auditing
- Data Gathering
- Data Reporting
- Critical Thinking
- Problem Solving
- Organizational Skills
- Reimbursement Methodologies
- Payment Practices
- Accreditation Knowledge
- NCQH Knowledge
- CMS Knowledge
- Billing Standards
- Customer Relationship Management
- Active Listening
- Effective Communication
- Vendor Consulting
- Program Support
- Flexibility
- Adaptability
- Credential verification
- Document review
Timeline
Credentialing Analyst II
Priority Health
05.2021 - Current
Provider Reimbursement Analyst II
Priority Health
08.2017 - 05.2021
Regional Billing Supervisor
spectrum health systems
06.2015 - 08.2017
Physician Revenue Cycle Supervisor
Mercy health
10.2014 - 06.2015
Provider Enrollment Analyst II
Priority Health
05.2013 - 10.2014
Bachelor - Health Services Administration
Baker College
Medical Assistant Diploma -
Davenport University
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