INDIRA EVELYN-SHERMAN
Cumming,Georgia
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
26
26
years of professional experience
1
1
Certification
Work History
Senior Provider Onboarding Specialist Credentialing
Delta Dental
09.2019 - Current
- Expert on provider contracting and credentialing tasks for all lines of business
- Responsible for analyzing escalations and providing root cause analysis to identify system/business process enhancements, and acts as a trainer and mentor to lower-level team members
- Assists in coordination and distribution of work; runs analytics on inventory to track if production expectations, performance guarantees, and customer service levels are being met
- Creates reports and analyzes data to identify solutions that meet business goals
- Maintains the integrity of an electronic database and assists team members and dental provider's offices with entering provider contract details, business name changes, tax ID changes, termination of dental contracts, change of ownership, sale of practice, adding associates, license changes, dental specialty changes, updated contract information, mgmnt exceptions and research of claims processing issues
- Acts as subject matter expert; Responsible for special handling accounts, escalations from team members, and participating in end-to-end process improvement, with emphasis on system enhancement and/or training gaps
- This includes assistance with the development of Test Cases for system enhancements or process improvement initiatives.
Credentialing Specialist
Ultimate Health Plans
03.2018 - 07.2019
- Cross-trained Prior Authorization Coordinator & Member Advocate Representative
- Perform insurance benefit verification for each member
- Receiving & inputting information into database of incoming authorization requests
- Communicating with various depts
- To research claims & resolve outstanding issues
- Perform verification on all applicable credentials
- Creates & updates provider information in the credentialing system to ensure that credentials are completed within a timely manner & accuracy
- Enroll members into LeadMaster, ensuring all necessary documentation & system updates are completed in a timely manner
- Verified & upload relevant documents as required
- Detailed & organized; ensuring each provider meet the standards of the insurance company
- Maintaining physician certificates & credentialing current.
Provider Network Support Coordinator
OptumServe
01.2017 - 03.2018
- Establish as the point of contact with providers on issues or concerns; responsible for the end-to-end process to resolve provider inquiries
- Verifying fee schedules and contractual terms with providers to ensure accuracy and agreement on terms, conducting provider follow up as necessary
- Operated as the liaison between Providers and Recruiters to initiate the credentialing process- compiled, uploaded, and updated provider contracts into the provider database
- Participate in weekly meetings with the providers/POC documenting discussions & issues
- Identify listed medical or psychological conditions, including all related conditions or triggers, and electronically index each according to their medical specialty
- Convert hard copy documents into an electronic PDF format which uploads into a centralized database
- Utilize a PDF program & high-speed production scanners for the purpose of transforming hard copy docs into an electronic format.
PST/Customer Service Support Representative
Laboratory Corporation of America
04.2015 - 06.2016
- Answered an average of 10 calls per day by addressing customer inquiries, and solving problems
- Performs a wide variety of administrative/clerical duties (i.e, payroll, paternity, testing, billing, data entry, and phlebotomy)
- Collection of billing information, specimen processing and client & customer service duties
- Successfully collected blood samples from patients and readied them for transport; provided a warm and friendly demeanor that alleviated fears and reduced patients' stress during procedures.
Lead Medical Assistant
Emory Specialty Associates/Emory @ Roswell
12.2011 - 08.2014
- Managed medication, stock room inventory and Quality Control
- Trained new staff on Quality Control procedures
- Assisted doctors with surgeries and non-invasive procedures
- Authorized drug refills and provided detailed prescription information to pharmacies
- Oversaw in- and out-patient care and treatment and ensured all medical records were updated with all medical information for each patient
- Ascertained vital signs, preliminary diagnosis and status to attending physicians and ensured follow up on all procedures and physicians' orders.
Clinical Office Manager
Alpharetta Women's Specialists
12.2009 - 12.2011
- Completed insurance claims input, followed up on insurance approval processes and notified patients on any insurance issues needing clarification
- Continually maintained and improved the company's reputation and positive image in the markets served
- Certified that equipment and supplies were properly maintained for quality patient care and safety
- Supervised and managed the daily activities of a clinical team consisting of 9 physicians, nurses and support staff
Medical Assistant
New Tampa Internal Medicine
09.2002 - 07.2009
- Provided clinical and administrative support for a high volume medical center and collaborated with physicians, supervisors and medical technologists in providing superior patient care and service
- Completed detailed specimen processing and culture inoculation processes
- Responded to patient questions, prescriptions, prior authorizations and referrals
- Performed EKGs, Spirometry, vital signs, phlebotomy and non-invasive procedures.
Medical Assistant
Pediatric Cardiology Associates
09.2001 - 09.2002
- Obtain and document patient health record
- Managed patient records, following all regulatory compliance on confidentiality and filed/retrieved patient files during office hours
- Perform all point of care testing, such as EKG tests.
Medical Assistant
HealthPoint Medical Group (BayCare)
10.1998 - 09.2001
- Served as the company's first line of contact as the receptionist for a high volume Pediatric practice; answered phones and scheduled patients based on physicians' calendar of availability
- Managed financial records and performed other bookkeeping duties, such as handling credit and collections & mailing monthly statements to patients
- Responsible for ordering medical and office supplies through accurate inventory management.
Education
No Degree - Medical Assisting
Erwin Technical Center
Tampa, Florida03.1998
Bachelor of Arts - Psychology
Texas Southern University
Houston, TX06.1996
No Degree - DIPLOMA
Lakewood High School
St. Petersburg, Florida06.1992
Skills
- Software Knowledge
- Policy understanding
- Performance Tracking
- New Hire Onboarding
- Training and mentoring
- Decision-Making
- Procedure Compliance
- Policy and Procedure Writing
- Data Analysis
- Multitasking
Certification
- ServSafe Food Handler's Certification
- Certified Doula [BEST] [2023 JULY]
- Childbirth Educator [BEST] [2023 OCTOBER]
- [Placenta Encapsulator] [BEST] [2024 JANUARY]
Languages
English
Native or Bilingual
Spanish
Limited Working
Timeline
Senior Provider Onboarding Specialist Credentialing
Delta Dental
09.2019 - Current
Credentialing Specialist
Ultimate Health Plans
03.2018 - 07.2019
Provider Network Support Coordinator
OptumServe
01.2017 - 03.2018
PST/Customer Service Support Representative
Laboratory Corporation of America
04.2015 - 06.2016
Lead Medical Assistant
Emory Specialty Associates/Emory @ Roswell
12.2011 - 08.2014
Clinical Office Manager
Alpharetta Women's Specialists
12.2009 - 12.2011
Medical Assistant
New Tampa Internal Medicine
09.2002 - 07.2009
Medical Assistant
Pediatric Cardiology Associates
09.2001 - 09.2002
Medical Assistant
HealthPoint Medical Group (BayCare)
10.1998 - 09.2001
No Degree - Medical Assisting
Erwin Technical Center
Bachelor of Arts - Psychology
Texas Southern University
No Degree - DIPLOMA
Lakewood High School
- ServSafe Food Handler's Certification
- Certified Doula [BEST] [2023 JULY]
- Childbirth Educator [BEST] [2023 OCTOBER]
- [Placenta Encapsulator] [BEST] [2024 JANUARY]
Similar Profiles
Sophia PalmerSophia Palmer
Provider concierge at Delta DentalProvider concierge at Delta Dental
Heaven BlankenshipHeaven Blankenship
Customer Service Representative at Delta DentalCustomer Service Representative at Delta Dental
Erika VillaErika Villa
Commercial Segment Marketing Specialist at Delta DentalCommercial Segment Marketing Specialist at Delta Dental