Freda Artina Thomas
Woodstock,Georgia
Summary
Experienced Medical Administrative Professional with a strong background in healthcare, medical claims billing, diagnostic and procedural coding, credentialing, provider enrollment, and office management. Collaborates with healthcare professionals and management to achieve budgetary goals. Ensures compliance with regulatory, medical, and NCQA requirements for timely reimbursements. Proficient in maintaining comprehensive and accurate databases, resolving complex issues, and fostering strong relationships with payers, providers, and vendors. Dedicated to upholding the highest standards of accuracy, ethics, and confidentiality in healthcare administration and practices.
Overview
9
9
years of professional experience
Work History
Credentialing Specialist (Contracted –Remote)
Broad Path
06.2024 - Current
- Assess and review initial Physician and Mid-levels applications for Noridian Medicare
- Review for any adverse, illegal, and quality of care issues before submission to committee
- Primary Source Verifications of all information required for application
- Heavy use of state, board, hospital affiliations, NPDB and other various websites
- Constant contact with medical staff offices, providers and point of contact individuals for required or missing information
- Continued training on NCQA requirements and updates for Credentialing
- Credentialing for Alaska, American Samoa, AZ, CA, Guam, HI, ID, MT, NV, ND, OR, SD, UT, WA WY
- Finalize and approve of enrollment applications for participation through PECOS
Provider Enrollment Specialist (Full-time Remote)
Grady Memorial Hospital
04.2021 - 10.2023
- Provide the enrollment for all new medical providers
- Perform changes and updates to existing provider files
- Review all provider data for the plan enrollment process
- Use of Council For Affordable Quality Healthcare (CAQH)
- Data Entry to CAQH for New and Existing providers
- Manage all Attestations within 120 days
- Made updates to Grady System MD-Staff of provider information
- Run monthly audit reports for missing or pending enrollments
- Process correspondence, emails and heavy communications with providers and administrators
- Many other duties
Credentialing Specialist (Part-time Remote) –Short Term Contract
Credential That LLC.
09.2020 - 04.2021
- Perform Physician credentialing for hospital privileges for various facilities in and out of the state of Georgia
- Use of CAQH Provider information for completion of initial State Applications
- Use of Cactus Credentialing System
- Data Entry of Physician information into Evips System for storage
- Use of Ticketing System Freshworks for tracking the completion of tasks
- Constant communication with Physicians, Hospital medical staff offices, Physician office staff and others regarding information required or needed for Application submittal
- Follow-up with providers on requested information from Facility if not on file with our office
Medical Claims Biller & Credentialing – (Part time Remote Contracted Position) – Randstad Agency
Center For The Visually Impaired
07.2020 - 09.2020
- Contracted to process un-billed claims, follow-up on unpaid claims, make necessary corrections to resubmit medical claims
- Performed Initial and additional location credentialing for Optometrists and Occupational therapist of the practice
- Medicare, Medicaid and Medicaid CMO’s, and commercial insurances using Medicare PECOS, Medicaid GAMMIS Systems, Availity and online application processes
- Use of CAQH, and other websites for Primary Source Verification and Clearance
- Use of Collaborate MD Practice Management System and EDI
- Daily work activity and claims billing reports to management
Credentialing Specialist (Contracted –Remote)
Broad Path
03.2020 - 07.2020
- Processed initial and re-credentialing of Physician and Mid-levels applications for major health insurance company in Oregon for committee approval
- Reviewed all Adverse, illegal, and quality of care issues before submission to committee
- Primary Source Verifications of all information required for application
- Heavy use of state, board, hospital affiliations, NPDB and other various websites
- Constant contact with medical staff offices, providers and point of contact individuals for required or missing information
- Continued training on NCQA requirements and updates for Credentialing
- Credentialed for MD
- OD, DC, LSW, NP, PA, ND, PSY-D, and others
- Bee-Hive Camera Monitoring
Credentialing Specialist (Contracted Position Through Ajilon Agency)
Netsmart
10.2019 - 01.2020
- Perform initial credentialing and CAQH updates on Physicians
- Submit applications electronically or by paper to insurance carriers
- Submission of applications by Roster or individual to insurance carriers
- Constant contact with educational institutions for physician’s information
- Contact Physicians for needed or required information
- Use of State licensure websites for verification of licenses
- Follow up on the processing of submitted applications to insurance carriers
- Credential Physicians for multi state clients
- Credentialing for Commercial, Governmental and Private insurance carriers
- Heavy phone contact with hospital medical staff offices and insurance carriers
- Faxing, Email and processing all correspondence as required
- Use of Avatar, CAQH, Cactus, VMWare softwares and more
Care Giver
Care Giver – For Parents
05.2018 - 10.2019
- Relocated to Kansas City, Missouri to take care of both parents due to poor health and 24 hour care
- I was compensated through their insurance’s for home health services
Medical Claims Specialist (Part-time)
Treatment Management Company
08.2017 - 05.2018
- Performed Behavioral Health Substance Abuse Facility claims follow-up using Edgemed and Advanced Data Systems (ADS) Practice Management System with EMR
- Converted to EPIC system February 2018
- Research, correct, re-submit, appeal and inquire about unpaid claims for in and outpatient services
- Contact all lines of insurance companies as an out of network provider
- Contact patients regarding insurance issues such as other information requested by the insurance companies, insurance payments paid to the patient, handle medical records requests from payers, handle all correspondence
- Physician Initial, Re-cred Credentialing
- CAQH Initiations and Attestations for In and Out of Network Providers
- Use of Availity, Navi-net, Cigna, United Healthcare and other insurance web portals
- High use of telephone and email contact with insurance companies and physicians
Medical Billing Specialist IV – (Remote)
RMB Inc
12.2015 - 08.2017
- Perform correction and follow up of Medicare Hospital and Professional claims for several hospital locations in California, West Virginia, New York and Utah, and Physician offices remotely from home
- Use of Medicare FISS/DDE Program for resubmission of Part A Claims and corrections Availity and other assigned portals
- Apply adjustments to accounts
- Use of Medicare Part B Noridian Portal to resolve claim issues and resubmissions
- Use of RCI Practice Management and EMR (Cerner System)
- Reporting weekly, training and meetings for insurance updates
- Work with Noridian, Palmetto and Cahaba GBA, NGS Medicare Jurisdictions, HMO, PPO and Specialty insurance markets
Education
Criminal Justice Administration and Sociology
Central Missouri State University
Warrensburg, Missouri01.1981
Skills
- HIPAA compliance
- Provider enrollment
- Background checks
- Data management
Training
- Medical Claims Billing
- CPT & ICD-10 Coding
- Credentialing
- CAQH
- HIPAA
- Provider Enrollment
- Medical Office Management
Values
- Bring fresh ideas to solving problems
- Creative Problem Solving
- Positive Sense of Humor
- Bottom Line Oriented
- Accomplish to set personal and professional goals
- Builds Confidence in others
- Dedication to personal and team ideas
Timeline
Credentialing Specialist (Contracted –Remote)
Broad Path
06.2024 - Current
Provider Enrollment Specialist (Full-time Remote)
Grady Memorial Hospital
04.2021 - 10.2023
Credentialing Specialist (Part-time Remote) –Short Term Contract
Credential That LLC.
09.2020 - 04.2021
Medical Claims Biller & Credentialing – (Part time Remote Contracted Position) – Randstad Agency
Center For The Visually Impaired
07.2020 - 09.2020
Credentialing Specialist (Contracted –Remote)
Broad Path
03.2020 - 07.2020
Credentialing Specialist (Contracted Position Through Ajilon Agency)
Netsmart
10.2019 - 01.2020
Care Giver
Care Giver – For Parents
05.2018 - 10.2019
Medical Claims Specialist (Part-time)
Treatment Management Company
08.2017 - 05.2018
Medical Billing Specialist IV – (Remote)
RMB Inc
12.2015 - 08.2017
Criminal Justice Administration and Sociology
Central Missouri State University
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