Summary
Overview
Work History
Skills
Experience
Timeline
Generic

Erin Stearns

Richmond,KY

Summary

Collaborative leader with dedication to partnering with coworkers to promote engaged, empowering work culture. Documented strengths in building and maintaining relationships with diverse range of stakeholders in dynamic, fast-paced settings.

Overview

11
11
years of professional experience

Work History

Manager, Credentialing & Payer Relations

Familia Dental
02.2022 - Current
  • Streamlined Credentialing and Payer Enrollment Processes by developing a collaborative team, implementing clearly defined policies and procedures, and setting goals driven by incentive & monitored through reporting. Expediting Credentialing & Enrollment timelines by 30 days.
  • Analyzed production by payer, provider specialty and office, quarterly, to prioritize network enrollment. Focusing the team’s efforts on networks where providers can be most productive, leading to $415k savings in baseline provider compensation, 36% improvement from the prior year.
  • Developed and maintained Payer Relationships by conducting quarterly calls to discuss partnership opportunities related to ensuring efficiency in our processes, cleanliness of provider data, compliance in our contracts and expedited reimbursement. Increasing awareness throughout the organization and directly contributing to a 45% decrease in production adjustments.
  • Collaborated in analyzing payer fee schedules identifying top 30 utilized codes based on production, comparing fees with other similar networks and UCR rates to lead the discussion in fee negotiations. Successfully lead negotiations for 2 priority payers contributing to an estimated net increase of $500k determined by prior year utilization.
  • Achieved 98% or better on all individual and team goals maximizing bonus potential.

Process Improvement Manager

Familia Dental
01.2021 - 02.2022
  • Collaborated in the implementation of a new practice management software into 42 office locations optimizing the patient experience and streamlining revenue cycle systems. Recognized by leadership as the Swiss army knife for my extensive knowledge in multiple areas of the organization, including Insurance benefits and eligibility, fee schedules, claims processing & ERA enrollment.
  • Coordinated training and support efforts for RCM processes that resulted in collection of over $3 million from a denial backlog project by leveraging my relationship with Payers.
  • Participated in the development of customizable software and automated solutions to add efficiency to multiple processes.

Supervisor, Provider and Payer Relations

Familia Dental
02.2018 - 01.2021
  • Lead a team of 5 Enrollment Specialist who handled all aspects of the payer enrollment process, including but not limited to contracting, credentialing, recredentialing, license renewals, roster reconciliation & network directory accuracy.
  • Facilitated onboarding and implementation of a third-party vendor specializing in robotic processes that streamlined the eligibility and benefits process. Freeing up time for office staff to focus on the patient experience.
  • Developed a payer relations specialist who collected & maintained fee schedules, created payer portals, monitored EFT enrollment, troubleshooted and escalated claim issues relating to under/over payments or provider enrollment issues.

Enrollment Administrator

Familia Dental
03.2013 - 02.2018
  • Partnered with new providers to gather all required information needed to enroll into each contracted insurance network.
  • Generated credentialing applications and reviewed for cleanliness and accuracy of provider data.
  • Submit credentialing applications to each insurance network and monitor progress of the application, submitting any additional information that may be requested.
  • Continual follow-up on all applications until an effective date is received and confirmed by the network that provider is now a participating dentist.
  • Maintain provider credentialing status by monitoring license renewals and recredentialing requirements.

Skills

  • Cross-Functional Teamwork
  • Analytical Thinking
  • Research
  • Critical Thinking
  • Negotiation and Conflict Resolution
  • Contract Management
  • Training and Development

Experience

  • Microsoft Products: Outlook, Teams, Excel, Word, Power Point, Sharepoint, Planner and Power Automate
  • Practice Management Systems: Denticon, Open Dental & Eaglesoft
  • Credentialing Software: CredentialSteam by VerityStream
  • Robotic Eligibility and Benefits: iSpace
  • Claim Clearing House: DentalXChange
  • Reporting Tools: PowerBi

Timeline

Manager, Credentialing & Payer Relations

Familia Dental
02.2022 - Current

Process Improvement Manager

Familia Dental
01.2021 - 02.2022

Supervisor, Provider and Payer Relations

Familia Dental
02.2018 - 01.2021

Enrollment Administrator

Familia Dental
03.2013 - 02.2018

Similar Profiles

CREATE PROFILE
Erin Stearns