JORDAN ROTHERMEL
Bakersfield,CA
Summary
Detail-oriented and methodical Credentialing/Billing Specialist offering 5 years of experience in Provider Credentialing and 1 year of Medical Billing experience. Exceptional abilities in conducting research, problem-solving and prioritizing simultaneous tasks. Leverages resourcefulness, critical thinking skills and superior work ethic for top job performance.
Overview
6
6
years of professional experience
Work History
CREDENTIALING/BILLING SPECIALIST
OPTIMAX CONSULTING SERVICES
01.2020 - Current
- Facilitate Provider Onboarding to begin the credentialing or re-credentialing process and reassign Medicare Benefits if applicable
- Utilize credentialing and EMR databases to maintain clinician information, track contracts/payors, process reports, and post charges for billing
- Contribute to weekly meetings with clients, providers, and staff for credentialing and billing updates
- Locate and resolve errors in rejected claims and communicate with insurance providers to resolve denied claims
- Research CPT and ICD-10 coding discrepancies for compliance and reimbursement accuracy
- File and update patient information and medical records
INTAKE/CREDENTIALING SPECIALIST/ADMIN. ASSISTANT
PSYCHIATRIC WELLNESS CENTER
02.2017 - 01.2020
- Answered phone calls and provided new clients with required paperwork to initiate service
- Collected, verified, recorded and processed client demographics, insurance payments, and referral information
- Worked with clinical and operations teams to facilitate client placement and obtain appropriate services for clients
- Facilitate Provider Onboarding to begin Credentialing/Re-Credentialing/Medicare Reassignment
- Maintain Provider files for the group practice, CAQH, PECOS and EMRs
- Restocked supplies and placed purchase orders to maintain adequate stock levels
- Negotiated contracts with vendors and suppliers for office supplies, equipment and services
- Created and maintained detailed administrative processes and procedures to drive efficiency and accuracy
- Increased office participation in special events by creating newsletter with detailed calendars and other office updates
- Scheduled office meetings and client appointments for staff teams
Education
Associate of Science - ADMINISTRATION OF JUSTICE
TAFT COLLEGE
Taft, CA12.2015
High School Diploma -
CENTENNIAL HIGH SCHOOL
Bakersfield, CA06.2011
Skills
- Application & Confidential Records Management
- Database Maintenance
- Solo Practitioner Credentialing & Group Credentialing
- Provider Enrollment & Insurance Credentialing Processes
- Credentialing Documentation
- Electronic Health Records Systems
- Claim Processing
- Auditing Proficiency
- Contract Agreement Preparation
- Insurance Eligibility Verifications
- Training and Development
- Administrative Support
Additional Information
Ability to navigate and properly utilize PECOS, CAQH and NPPES for Provider Credentialing and Medicare Enrollment/Reassignment. Familiar with Medicare and Medi-cal Provider Enrollment. Proficient in understanding Provider license types, certifications, specialties, etc. Able to identify inpatient and outpatient Credentialing requirements. Expert level knowledge (7 years experience) regarding Behavioral Health/Mental Health Providers and Insurance Payers/Third Party Administrators. 1 year of Hyperbaric and Wound Care charge posting and claims submission. Basic knowledge in Home Health billing, such as identifying Certifications and Recertification's.
Timeline
CREDENTIALING/BILLING SPECIALIST
OPTIMAX CONSULTING SERVICES
01.2020 - Current
INTAKE/CREDENTIALING SPECIALIST/ADMIN. ASSISTANT
PSYCHIATRIC WELLNESS CENTER
02.2017 - 01.2020
Associate of Science - ADMINISTRATION OF JUSTICE
TAFT COLLEGE
High School Diploma -
CENTENNIAL HIGH SCHOOL
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