KELLI R. STEWART
Odenton,MD
Summary
Dedicated and focused professional with over 10 years of experience in medical billing, coding, insurance claims and healthcare administration in various diverse industries. Possesses a solid track record for accurately translating medical terms in an efficient manner. Detail-oriented, multi-tasker with strong communication skills. Possesses solid critical thinking skills used to help resolve billing discrepancies, increase revenue and reduce accounts receivables within an organization. Works well under pressure, attentive and has a true passion for helping people. Aiming to leverage my extensive career experience and proven knowledge to successfully fulfill the position within your organization.
Overview
7
7
years of professional experience
Work History
Provider Enrollment Analyst
CGS LLC/Medix Healthcare Solutions
Nashville, TX
08.2024 - Current
- Application Review: Determines the acceptability of provider enrollment applications, including initial applications, reenrollment, reactivation, and change of information
- Data Verification: Conducts in-depth review and verification of provider data, utilizing various databases and organizations to ensure authenticity
- Database Management: Processes, enters, and updates provider data information/applications into the appropriate enrollment database for tracking and evaluation
- Customer Service: Provides quality service and communicates effectively with external and internal customers in response to inquiries via correspondence and telephone
- Discrepancy Resolution: Obtains information from internal departments, providers, and government/private agencies to resolve discrepancies and problems.
Provider Enrollment and Data Specialist
AmeriCartias Health (NTT DATA Services)
Texarkana, TX
04.2023 - 01.2024
- Patient Relations: Initiate and receive patient calls to resolve billing and payment inquiries, fostering a positive patient experience
- Payment Processing: Efficiently process and post payments, researching and resolving any outstanding payment issues in a timely manner
- Problem-Solving: Demonstrated excellent problem-solving skills when addressing complex issues or discrepancies in the credentialing application process for over 25 healthcare providers
- Prioritization: Managed multiple priorities effectively, resulting in on-time completion of credentialing tasks for numerous providers simultaneously
- NPI Management: Obtained National Provider Identifier (NPI) numbers for providers and facilities, ensuring updated profiles for regulatory compliance
- Provider Enrollment: Enrolled providers in Medicaid, Medicare, and private insurance plans, streamlining the onboarding process
- Record Management: Added providers to various group entities and managed terminations, ensuring accurate documentation and compliance with organizational policies.
Medical Records Retrieval Specialist/Pre-Screening Specialist
Blue Cross Blue Shield of Louisiana
Baton Rouge, LA
08.2020 - 09.2021
- Data Entry: Enters medical credentialing and facility applications into healthcare management systems for appropriate departmental review and approval
- Information Validation: Validates patient information, insurance eligibility, and benefit information for accurate processing
- Correspondence Preparation: Prepares correspondence to practitioners to obtain missing information required for the facility application process
- Application Processing: Utilizes IPD, Healthcare FACETS, Provider Manager database, and Provider Query Tools to successfully process over 25 applications per day
- Provider Verification: Verifies provider demographics, billing, address, and profile information to ensure accuracy
- Document Compilation: Compiles contractual agreement documents, licenses, Certificates of Insurance, and demographic updates for recordkeeping and review
- Team Collaboration: Communicates and collaborates across teams and departments to resolve any issues efficiently.
Provider Data Specialist
Versant Healthcare
Baltimore, MD
02.2020 - 04.2020
- 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.
Medical Record Retrieval Specialist
CareFirst BlueCross Blue Shield
Owings Mills, MD
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.
Provider Credentialing Specialist
Cigna Health Spring
Rockville, MD
11.2017 - 07.2018
- 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.
Education
Workforce/Exchange Program -
Anne Arundel County
MD, Annapolis01.2010
High School Diploma -
Annapolis High School
Annapolis, MDSkills
- Medical Billing Expert
- Claims Processor
- Team Player
- Credentialing
- Medical Terminology Proficient
- Multi-Tasker
- Strong Organizational Skills
- Electronic Medical Records
- Solid Interpersonal Skills
- Problem Solver
- Credential verification
- HIPAA Compliance
- Data Collection & Processing
- Flexible & Adaptable
References
Available on request
Communityoutreach
LIFE COACH Helps people spiritually connect with their purpose in life by helping them overcome fears that hold them back from reaching their personal goals.
Timeline
Provider Enrollment Analyst
CGS LLC/Medix Healthcare Solutions
08.2024 - Current
Provider Enrollment and Data Specialist
AmeriCartias Health (NTT DATA Services)
04.2023 - 01.2024
Medical Records Retrieval Specialist/Pre-Screening Specialist
Blue Cross Blue Shield of Louisiana
08.2020 - 09.2021
Provider Data Specialist
Versant Healthcare
02.2020 - 04.2020
Medical Record Retrieval Specialist
CareFirst BlueCross Blue Shield
09.2018 - 10.2019
Provider Credentialing Specialist
Cigna Health Spring
11.2017 - 07.2018
Workforce/Exchange Program -
Anne Arundel County
High School Diploma -
Annapolis High School
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