Diane Wade
Citrus Heights,CA
Summary
To obtain a challenging position within a company that uses my knowledge and passion for helping others.
Overview
19
19
years of professional experience
Work History
Credentialing Specialist III
Sutter Health
03.2017 - Current
- Collaborated with healthcare providers to gather necessary information for accurate credentialing decisions.
- Managed multiple priorities effectively, resulting in the on-time completion of credentialing tasks for numerous providers simultaneously.
- Conducted audits of provider files, ensuring all necessary documents were up-to-date and compliant with regulatory requirements.
- Enrolled providers and Medicaid, Medicare, and private insurance plans.
- Responsible for submitting SAMs and working with clinicians with their on boarding access.
Patient Advocate/Administrative Representative
Sutter Medical Foundation
08.2015 - 03.2017
- Processes all formal complaints received either from a member, health plan or other source ensuring that the policy and procedures for SMG, SWMG, SNSMG, SECMC, SIP and SMFAS are followed and that all quality of care issues are handled confidentially and directed to the appropriate Quality Committee
- Reporting Data and scanning medical records
- Acts as a resource to Physician-in-Chief, Medical Group Administrators, Sr
- Leadership and new physicians as well as to managers/supervisors; communicating areas of concerns and identifying trend areas
- Assists managers/supervisors in responding to patient complaints
- Acts as staff resource which includes communicating and clarifying organizational policies and procedures
- Assists patients in utilizing appropriate medical services and understanding available medical related services including policies, procedures, protocols and regulations that pertain to the department as well as the medical center
- Investigates all issues related to patients' complaints including collection and documentation of appropriate data
- Ensures that complaints and grievances are processed in accordance with regulations, compliance standards, policies and procedures
- Processes member discharge requests from clinicians per disenrollment/better matched policy and procedure
- Checks eligibility, benefits, authorization requirements, PCP approval requirements, and billing requirements
- Comprehensive knowledge of healthcare issues, health plan regulations and requirements, regulatory agencies such as Joint Commission, NCQA, CMS and Title 22 and experience dealing with such agencies in matters related to the patient complaint/grievance process
- Knowledge of medical terminology, medical practices and procedures, and experience with medical record review techniques
Patient Representative
Sutter Gould Medical Foundation
01.2015 - 01.2017
- Working as a patient representative interacting with and providing great service to patients and their families, including responding to questions, filling out paperwork, providing information, and serving as liaisons for their institutions
- Resolve questions/concerns; provides management with information and documentation; assists patients with concerns related to quality of care, medication assistance and general information
Field Expeditor/Customer Service
Complex Legal Services
01.2015 - 12.2015
- Working as an expeditor for out of state subpoenaed records consisting of making between 80-100 calls to medical providers to ask them to provide documentation necessary for litigation while following the HIPPA laws
- Make and receive phone calls to schedule copying of documents, Getting requested document for trial cases
Pharmacy Technician/Narcotic Compliance/Customer Service
Omnicare Pharmacy
01.2010 - 12.2014
- Working in a general office/call center environment responsibilities include receive incoming calls for refills for medications, taking messages and transferring phone calls
- Making copies and faxing documents
- Also assisting nurses and doctors with information regarding patient’s medications and order status
- Making outgoing phone calls to doctor offices regarding Narcotic medications promoting compliance with federal state and pharmacy laws
- Electronically processing refill requests, Updating Patient records, Also Training and Overseeing new Employees
AARP Customer Service Representative (Temp)
Teletech
01.2007 - 12.2009
- Receive incoming calls, educating callers on Medicare and Prescription Drug offerings
- Process customer requests in a timely manner
- Update online records, respond to billing and payment inquiries and research participant program status
Cashier, Merchandising
J.C Penney
01.2006 - 12.2007
- Responsible for customer service, ensuring merchandise displays meet company standards, ensure merchandise levels throughout the store are adequate to meet shopping demands
- Receive incoming calls for refills, taking messages & transferring phone calls making copies & faxing documents
Education
Capella University - Business and Healthcare Management
Capella University
12.2020
Pharmacy Technician Program -
TechSkills of California
Sacramento01.2010
Skills
- Productive worker
- Solid work ethic
- Flexible team player
- Ability to prioritize
- Juggle multiple projects
- Resourceful
- Building trusting relationships
- Microsoft Word
- Microsoft Excel
- Microsoft Outlook
- Exceptional Customer Service
- Medicare Part D
- Acquainted with Brand/Generic Drugs
- Medical Terminology
- Typing 45 WPM
References
Available upon request
Timeline
Credentialing Specialist III
Sutter Health
03.2017 - Current
Patient Advocate/Administrative Representative
Sutter Medical Foundation
08.2015 - 03.2017
Patient Representative
Sutter Gould Medical Foundation
01.2015 - 01.2017
Field Expeditor/Customer Service
Complex Legal Services
01.2015 - 12.2015
Pharmacy Technician/Narcotic Compliance/Customer Service
Omnicare Pharmacy
01.2010 - 12.2014
AARP Customer Service Representative (Temp)
Teletech
01.2007 - 12.2009
Cashier, Merchandising
J.C Penney
01.2006 - 12.2007
Capella University - Business and Healthcare Management
Capella University
Pharmacy Technician Program -
TechSkills of California
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