Jamie Pepin
Quincy,IL
Summary
Credentialing Specialist adept at conducting application reviews and primary source verifications. Excellent relationship-building, problem-solving and communication skills.
Overview
28
28
years of professional experience
Work History
Credentialing Coordinator
Quincy Medical Group
12.2021 - Current
- Coordinated and monitored the renewal of all provider licenses and new licensure in the state of Illinois, Missouri, and Iowa
- Onboarding of new providers, which consists of enrolling in health plans, assisting with hospital privileges, and licenses
- Collaborated with peers across departments to ensure timely completion of credentialing activities.
- Maintained accurate documentation of all provider information, including licensure status, privileges granted, reappointment and renewal dates, and disciplinary action taken.
- Created reports on credentialing activities for management review and tracking purposes.
- Utilized various software applications to accurately manage data related to credentialing processes.
- Facilitated communication between providers and third-party payers regarding enrollment information.
- Assisted with onboarding new providers by verifying credentials according to established standards.
- Drafted letters and forms to communicate changes or updates regarding the credentialing process to providers.
- Conducted comprehensive research to verify license, certification, education, training and other credentials for healthcare professionals.
- Completed credentialing and re-credentialing applications to process files and applications.
- Populated, updated and maintained credentialing software and filing systems.
- Obtained appropriate documents from various resources to complete applications.
Human Resources Credentialing Assistant
Quincy Medical Group
12.2016 - 12.2021
- Assisted in the process of credentialing the companies physicians and providers
- This consisted of assisting the physicians with licensure applications, licensure renewals, hospital reappointments
- This work also encompassed setting up new providers with the health plans that were accepted by the company, providing support with new licensure applications and supporting documents
- There was also follow up work after the submission to the health plans, which involved reaching out to the health plans either by phone or email
- This position also included detailed work that would need to be sent out yearly to the health plans or to the health plans that were newly contracted with the group
- I would also assist in the general Human Resources duties which included, answering phones, assisting employees with questions, assisting co-workers with small projects.
Pre Certification Rep
Quincy Medical Group
01.2014 - 12.2016
- Calling/processing online/faxing Health insurance companies for patients to pre authorize medical services/faxing medical records for pre authorizations/verifying benefits for patients with health insurance companies/completing appeals for patients of denied services
- This involved communication with both medical providers/health insurance companies and the actual patient.
- Monitored the status of pending authorizations through follow up calls with providers offices.
- Successfully collaborated with providers to obtain authorization for treatments and procedures.
- Accurately documented all activities associated with pre-authorization requests within the appropriate systems and databases.
Administrative Assistant
Quincy Medical Group (through Manpower)
10.2013 - 01.2014
- Answering phone, data entry, assisting mainly in the Human Resources department, filing, verifying documents and assisting with a variety of tasks - including benefits, and training.
Office Assistant
Quincy Family Foot Care
03.2013 - 04.2013
- Answering phone and scheduling appointments, filing, some accounts receivable
Claims Examiner
Blue Cross/Blue Shield of Illinois
04.2007 - 01.2013
- Daily processing, reviewing, and investigation of claims received
- Calling, faxing, filing billing providers for additional information to finalize claims process
- Researching Additional information received from billing providers on claims under review or previously processed
- Assisting inquiry (customer service area) department with maintenance and updating members' files and claims adjudication.
Claims Processor
Blue Cross/Blue Shield of Illinois
08.1999 - 04.2007
- Processing of claims on a daily basis for the department
- Assisting other books of business/departments with the processing of their claims
- Filing of paperwork, calling and faxing info to and from billing providers.
Bank Teller
First Federal Bank
01.1996 - 08.1999
- Provided excellent customer service in a banking environment, including cash handling and account inquiries.
- Balanced cash drawer and maintained full accountability for assigned cash on hand.
- Greeted customers with professionalism and friendly and courteous demeanor.
- Answered customer questions regarding account information, transaction processing and fees.
- Issued cashier's checks, bank checks, money orders and traveler's checks.
- Adhered to security and regulatory requirements surrounding financial transactions.
- Kept work station neat, clean and well stocked with supplies and brochure materials.
- Responded to banking inquiries and requests from customers.
- Processed ATM deposits and reconciled against reports
Education
Southeastern High School
Augusta, ILSkills
- Multitasking
- Credentialing Software
- Re-credentialing processes
- Records and file management
- Provider enrollment
- Data Entry
References
Available upon request
Timeline
Credentialing Coordinator
Quincy Medical Group
12.2021 - Current
Human Resources Credentialing Assistant
Quincy Medical Group
12.2016 - 12.2021
Pre Certification Rep
Quincy Medical Group
01.2014 - 12.2016
Administrative Assistant
Quincy Medical Group (through Manpower)
10.2013 - 01.2014
Office Assistant
Quincy Family Foot Care
03.2013 - 04.2013
Claims Examiner
Blue Cross/Blue Shield of Illinois
04.2007 - 01.2013
Claims Processor
Blue Cross/Blue Shield of Illinois
08.1999 - 04.2007
Bank Teller
First Federal Bank
01.1996 - 08.1999
Southeastern High School