Josy Cole
Idaho City,ID
Summary
Detail-oriented professional with expertise in Excel, data management, and problem-solving. Proven track record in maintaining data integrity and ensuring accurate claims processing in high-volume environments.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Provider Data Management
Pacificsource
Boise, ID
08.2024 - Current
- Provides internal support to the Provider Network Department.
- Monitoring the faxes, emails, mail, files and other sources of incoming provider data notifications to ensure that provider network data is processed in a timely manner.
- Entering provider data into PacificSource systems for new and recredentialed network providers accurately and in a timely manner, consistent with department service level expectations and individual specialists' performance objectives. Ensuring accurate contract rows are added to ensure correct claims payments.
- Verifying licensure, Medicare and Medicaid eligibility through compliance approved tools; State license websites, Nordian Health solutions, CMS Ordering and Referring Information website, Medicare.gov, and Physician Compare database.
- Enter non-par facility/provider in the claims system for claims that pend. Verifying eligibility through approved sites, NPI through NPPES Registry, and adding non-par contract rows for correct payment processing.
- Attend meetings on a regular and ad hoc basis.
- Validates the data to be housed on provider databases and ensuring adherence to business and system requirements of customers as it pertains to contracting, network management, and credentialing, while maintaining current on up-to-date rules and regulations.
- Supports the ongoing maintenance and data integrity of the provider information and provides research analysis as needed.
- Building the facility/provider file in the claims' payment system(s).
- Review and processing of claims within Facets. Attaching claims to the correct Practitioner, Facility, and/or Group record to ensure correct claims payment. Includes reviewing the claim submission has been done appropriately based on state and government regulations in processing claims payments.
- Determines the accurate assignment of the appropriate network agreements that define payment specifications for the individual provider group or facility. Utilizing agreement matrix tools for states, lines of business, and contract agreements.
Customer Support Specialist
PacificSource
Boise, ID
01.2023 - 08.2024
- Work efficiently in a high-volume call environment while maintaining a professional, positive, and caring demeanor.
- Assist callers with coverage related questions/concerns; accurately interpret policy provisions for assigned products.
- Analyze customer's inquiries and determine correct steps for resolution, interpret benefit information, and claim processing accuracy.
- Work efficiently in multiple systems simultaneously while effectively utilizing critical thinking and problem-solving skills.
- Document calls in a clear and consistent manner in the computer system.
- Conduct appropriate research, take ownership, and follow through for prompt resolution of disputed claims.
- Relaying information to appropriate departments and personnel using established communication channels and procedures.
- Making outbound calls to members as necessary.
EVS (Environmental Service)
St Lukes
Boise, ID
08.2021 - 12.2022
- Providing support to the CNA's as well as the RN's.
- Monitoring the System used to see which projects are completed and still need to be completed as well as which projects take priority.
- Entering data into systems accurately and in a timely manner so everybody knows the project is complete and ready for the next use.
- Attended department meetings every morning.
- Validating data via the system used to ensure adherence to priority projects and staying up to date on all policy and procedures to keep the project to the high standard for the patients and staff members.
- Maintaining a positive and effective working relationship with team members and other departments to get the job done in a timely manner.
Janitor/Rover
Basin Elementary
Idaho City, ID
09.2019 - 08.2021
- Taking inventory of products and logging them on paper form and excel.
- Always following the FIFO rule.
- Remained flexible with my schedule to work around meetings in the department I was assigned.
- Creating a tracking system to create a lean process.
Team Lead
Western Power Sports
Boise, ID
06.2018 - 08.2019
- Trusted to train employees on verifying order forms, scanning and logging orders into our systems and packing items.
- Attend monthly meetings to go over our stats as well as safety meetings.
Education
Certificates - Excel
Miss Excel
Online05-2025
Certificate - Type Two Wildland Firefighter Cert.
TimberLake Job Corps
Estacada, OR09.2012
Diploma -
Borah High School
Boise, ID05.2011
Skills
- Excel
- Formatting
- Conditional formatting
- Cleaning data
- Functions
- Lookup functions
- Analysis tools
- Pivot tables
- Reviewing
- Troubleshooting
- Customizations
- Collaborations
- Creating macros
- VBA
- AI
- Strengths
- Weaknesses
- Prompt engineering
- Writing hacks
- Analysis sentiment
- Complex spreadsheet functions
- Custom macros
- Power BI
- Organizing data
- Connecting data
- Map of Power Query Editor
- Quality control tools
- Transforming data
- Replacing values
- Splitting columns
- Merging columns
- Rounding data
- conditional columns
- Creating custom columns
- Grouping data
- Customized refresh
- Merging queries
- Appending queries
- Building relationships
- Designing data visualizations
- Building Power BI reports
- Analyzing reports
- AI in Power BI
- M365 integrations
- Data entry
- Problem solving
- Customer service
- Research analysis
- Time management
- Attention to detail
- Provider data management
- Data privacy awareness
- Data recording and analysis
- Reference data management
Programs
- Facets
- OnBase
- Teams
- E-Search
- Payer
- MMIS
- RDV
- Excel
Accomplishments
Accomplishments Provider Ops -2025
- Created PDM Helpdesk teams’ channel. 6.4.25
- Submitted training resource opportunities to L&D department (MISS EXCEL). 5.20.25
- Attending mini-Kaizen: Suggested monthly small group training (hosted by 2 lv 3 that are on rotation each month) on most brought up issues in the PDM helpdesk channel or what needs worked on for PRSIM. 8.13.25, 8.20.25
- Created IPA Info Sheet. 4.16.25 Helping Credentialing department email projects. 6.5.25 – 8.7.25
Certification
Miss Excel 2025-Current
- AI 5.17.25
- Excel Dashboard Mini Course 4.5.25
- The Excelerator Course 5.23.25
Affiliations
- BBBS (Big Brother Big Sister)
- Hunting
- Volunteering (through work opportunities or in my small community)
References
References available upon request.
Timeline
Provider Data Management
Pacificsource
08.2024 - Current
Customer Support Specialist
PacificSource
01.2023 - 08.2024
EVS (Environmental Service)
St Lukes
08.2021 - 12.2022
Janitor/Rover
Basin Elementary
09.2019 - 08.2021
Team Lead
Western Power Sports
06.2018 - 08.2019
Certificates - Excel
Miss Excel
Certificate - Type Two Wildland Firefighter Cert.
TimberLake Job Corps
Diploma -
Borah High School