Kelli Stewart
Odenton,Maryland
Summary
Dedicated worker with excellent communication,.
To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
11
11
years of professional experience
Work History
Credentialing Specialist/ Medix Solutions
Cigna-HealthSpring
09.2015 - 08.2016
- Efficiently credentialed all new providers and managed the process of entering all provider data into the QNXT system;
- Provided quality customer service and support to practitioners, nurses, managers and teams to ensure best practices for onboarding providers;
- Handled procedures for terminating providers' contracts;
- Reviewed and analyzed projects and contracts before adding them to group affiliations;
- Obtained NPI numbers for providers and facilities and updated existing profiles.
- Received and evaluated applications to look for missing and inaccurate information.
Data Entry Operator
CVS PHARMACY-ATENA/ Quality Staffing Of America
12.2021 - Current
- Maintain databases by entering new and updated faxes and related information
- Verifies data and prepares materials for PDF printing
- Maintain data entry requirements by following data program techniques
- Upload OPT OUT faxes in the SharePoint database
- Followed standard operating procedures for maintaining accurate and readily retrievable accountability faxes
- Corrected data entry errors to prevent later issues such as duplication or data degradation.
- Obtained scanned records and uploaded into database.
- Identified data entry errors and reported to necessary departments.
- Added documents to file records and created new records to support filing needs.
- Produced monthly reports using advanced Excel spreadsheet functions.
Provider Data Specialist
Versant Healthcare / Robert Half Staffing
02.2020 - 08.2021
- As contractor, responsible for evaluating and verifying medical claims;
- Managed, updated and maintained provider information, credentials, medical billing codes and demographics within an electronic filing system;
- Verified provider information, vendor numbers, address, reimbursement logs and active codes;
- Processed 80-100 electronic and paper claims per day and updated record status;
PRE-SCREENING SPECIALIST
Blue Cross Blue Shield Of LA/ Capital Staffing
08.2020 - 09.2021
- Enters medical credentialing and facility applications into the healthcare management systems for appropriate departments to review and approve
- Validates patient information, insurance, eligibility, and benefit information for processing;
- Prepares correspondence to practitioners to obtain missing information required to complete the facility application process;
- Utilizes IPD, Healthcare FACETS, Provider Manager database, and Provider Query Tools to successfully process over 25 applications per day;
- Verifies provider demographics, billing, address and profile information;
- Compiles contractual agreement documents, licenses, Certificates of Insurance and demographic updates for recordkeeping and review;
- Provides consistent, professional, high-quality client support and services at all times;
- Communicates and collaborates across teams and departments to help resolve any issues;
MEDICAL RECORD RETRIEVAL SPECIALIST
CareFirst BlueCross Blue Shield/Adecco Staffing
09.2018 - 10.2019
- Maintained the Risk Adjustment Database within PeopleSoft;
- Identified, analyzed and performed quality control to address any outstanding issues related to incoming documentation, medical records, claims and other correspondence;
- Communicated with physicians, nurses, stakeholders and third-party vendors to research and locate appropriate medical records and import information as required;
- Proactively developed new quality control procedures and processes to establish process improvements;
- Provided support on all task and projects for the Risk Adjustment initiatives;
- Educated, trained and supported the providers' staff;
- Maintained accurate and timely recordkeeping, and verified processes were in compliance with HIPPA laws, guidelines to protect patient information;
DATA ENTRY CLERK
Trizetto Healthcare , Robert Half Solutions
05.2016 - 05.2017
- Served as contractor responsible for overseeing the entire claims process which included, verifying coverage, determining service eligibility, establishing benefits and securing payment from patients;
- Entered pertinent data into the online claims CITRIX XenApp database using information from health care claims forms CMS/HCFA 1500 and UB04;
- Maintained, updated and submitted detailed rejection claims reports and updates as required;
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
Credentialing Specialist
Cigna Health Spring/ Medix Solutions
11.2015 - 09.2016
- Conducted primary source verifications such as background checks and board certifications.
- Received and evaluated applications to look for missing and inaccurate information.
- Obtained NPI numbers for providers and facilities and updated existing profiles.
- Enrolled providers and Medicaid, Medicare and private insurance plans.
Billing Specialist
Maxim Healthcare Services/Contractor
09.2014 - 03.2015
- Performed research on over 485 flu vaccine immunizations and entered data into the Georgia Immunization
- Registry, known as GRITS, system;
- Initiated, reviewed and completed coding, billing, payment processing and patient data in an accurate and confidential manner, in accordance with HIPPA regulations and guidelines;
- Managed reports and ensured accuracy of patient insurance claims, statements and payment completion;
- Used data entry skills to accurately document and input statements.
CUSTOMER SERVICE REPRESENTATIVE
Johns Hopkins Healthcare, LLC
01.2012 - 07.2014
- Performed general office administrative support by answering, routing and documenting all inbound calls into the customer service tracking system, MC400;
- Utilized the database (MC400), to research and verify claim status, patient eligibility, benefits and payments required;
- Determined insurance claims appeals status and notified customer and providers as needed;
- Answered customer telephone calls promptly to avoid on-hold wait times.
- Educated customers about billing, payment processing and support policies and procedures.
- Met customer call guidelines for service levels, handle time and productivity.
- Quickly and accurately answered customer questions, suggested effective solutions and resolved issues to increase customer satisfaction 90%.
Education
Annapolis High School
Annapolis, MD06.1994
Skills
- Ability Multi Task
- Problem-Solving Teamwork
- Time Management Conflict Resolution Attention To Detail Active Listenin
- HIPAA Guidelines
- File and Records Management
- Computer Software
- Problem Resolution
- Clerical Support
- Medical Claims
- Document Editing
- Microsoft Office
- Medical Terminology
- Source Documentation
- Data Review and Verification
- Verifying Dates
- Correct Errors
- Database Updating
- Email Communication
- Entry Verification
- Trained in 10-Key
- Verify Data
- Typing
- Data Collection
- Data Input
- Compiling Data
- Word Processing
- Verifying Data Accuracy
- Efficient Data Entry
Timeline
Data Entry Operator
CVS PHARMACY-ATENA/ Quality Staffing Of America
12.2021 - Current
PRE-SCREENING SPECIALIST
Blue Cross Blue Shield Of LA/ Capital Staffing
08.2020 - 09.2021
Provider Data Specialist
Versant Healthcare / Robert Half Staffing
02.2020 - 08.2021
MEDICAL RECORD RETRIEVAL SPECIALIST
CareFirst BlueCross Blue Shield/Adecco Staffing
09.2018 - 10.2019
DATA ENTRY CLERK
Trizetto Healthcare , Robert Half Solutions
05.2016 - 05.2017
Credentialing Specialist
Cigna Health Spring/ Medix Solutions
11.2015 - 09.2016
Credentialing Specialist/ Medix Solutions
Cigna-HealthSpring
09.2015 - 08.2016
Billing Specialist
Maxim Healthcare Services/Contractor
09.2014 - 03.2015
CUSTOMER SERVICE REPRESENTATIVE
Johns Hopkins Healthcare, LLC
01.2012 - 07.2014
Annapolis High School
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