Edmund Smith
Payer Enrollment Specialist
Minnetonka,MN
Summary
Ambitious Credentialing Specialist with exemplary listening and communication skills. Adept at planning, organizing and facilitating enrollment process. Dedicated to keeping customers happy and maximizing employee participation.
Overview
6
6
years of professional experience
2
2
years of post-secondary education
Work History
Payer Enrollment Specialist
Virtual Radiology
Eden Prairie, MN
03.2021 - 08.2021
- Timely completion and submission of credentialing/provider enrollment applications for all providers to clients
- Facilitated state licensing, DEA registration, and liability insurance applications/renewals for providers; and assurance of timely completion of reappointment/re-credentialing forms.
- Served as a liaison between the radiologists, hospital medical staff offices, and contracted third party payers in coordinating the credentialing /provider enrollment processes.
- Responsible for timely and accurate maintenance of information in the credentialing databases and resolution of system edits.
- Maintained detailed and accurate records between multiple databases and programs
- Cultivate and maintain business relationships with payer partners
- Working with providers to maintain Medicaid and Medicare enrollments with client facilities based in multiple states
- Communicated effectively via telephone, email and in person with prospective customers.
- Updated, entered and reviewed customer data.
- Maintained physical and electronic provider files.
Credentialing Representative
Optum
Eden Prairie, MN
08.2017 - 03.2021
- Conducted audits and provide feedback to reduce errors and improve processes and performance
- Helped process provider applications and re-applications including initial mailing, review and loading into the database tracking system
- Assisting providers and credentialing contacts at provider groups in ensuring applications were correctly filled in, answering questions/concerns, and finding the appropriate person if I am unable to fulfill needs of the provider for their questions or concerns
- Working with compliance workflows and processes, including NCQA policies and practices
- Researching and applying government regulatory information
- Processing providers within multiple states regulatory information and specific requirements
- Developed and maintained positive customer relations and coordinated with team members to properly handle requests and questions.
- Responded to customer questions via telephone and written correspondence regarding documents required to complete application and walking through the online provider portal
- Provided basic technical support resolving issues for clients on provider portal and assisting them to reach the correct place to get further assistance if required
Pediatric Neuropsychology Admin. Coordinator
UMPhysicians- Pediatric Outpatient Clinics
Minneapolis, MN
12.2016 - 08.2017
- Schedule new and return neuropsychological and autism evaluations for our group of doctors
- Manage and updated weekly/monthly team calendars to facilitate postdoctoral scheduling of patients on each individual doctor's clinic days
- Work directly with doctor's to resolve scheduling of special requests and patient add-ons
- Gather additional information from outside clinic's, school districts, social workers and attorneys
- Act as liaison between other specialties within UMPhysicians to coordinate evaluations for out of state/country patients who need to see multiple providers in a short amount of time (Oncology, hematology, pre-transplant workups and yearly re evaluations)
- Review and process incoming paperwork from parents, schools, doctors, etc. for evaluations and give a brief overview to each doctor and their supervising doctor for each patient
- Create and maintain management level dashboards and activity tracking report
- Maintain daily tracking log showing each patient contact, what action was completed/outcome to ensure accountability
- Assist doctors in choosing individual patients based upon the referral and intake paperwork
- Reduced intake processes time by developing application tracking and filing systems.
- Handled patient scheduling, check-in, check-out and processing.
- Monitored and directed incoming mail and prepared outgoing mail.
- Addressed questions and managed communications with patients and insurance agents.
- Prepared detailed documents and reports in adherence administrative processes.
Community Referral Spec./Sr. Pediatric Coordinator
UMPhysicians- Pediatric Outpatient Clinics
Minneapolis, MN
12.2014 - 01.2016
- Registration and scheduling of new and return patients to one or more of the 34 separate pediatric specialty clinics
- Administrative backup for pediatric rheumatology scheduling new patients and contact for doctors
- Managed clinic internal message pools and the hospital's discharges for scheduling and contacting patients' families
- Reached out to patients and their families while in clinic for scheduling needs and coordination
- Resolve patient and provider complications and find solutions
- Complete daily work queues for pediatric clinics
- Coordinated complex patient appointments from hospital discharges and follow up
Education
Associate of Science - Fire Sciences
Hennepin Technical College
Eden Prairie, MN 08.2012 - 02.2014
Skills
Data entry skills
Customer service background
Maintaining records
Confidentiality understanding
Enrollment requirements
Team leadership skills
Coordinating paperwork
Coordinating applications
Adaptability
Timeline
Payer Enrollment Specialist
Virtual Radiology
03.2021 - 08.2021
Credentialing Representative
Optum
08.2017 - 03.2021
Pediatric Neuropsychology Admin. Coordinator
UMPhysicians- Pediatric Outpatient Clinics
12.2016 - 08.2017
Community Referral Spec./Sr. Pediatric Coordinator
UMPhysicians- Pediatric Outpatient Clinics
12.2014 - 01.2016
Associate of Science - Fire Sciences
Hennepin Technical College
08.2012 - 02.2014