Kimmerly Trappier
Andrews,SC
Summary
Seeking a position that fully utilizes experience, training, skills, and energy to contribute to profitability, teamwork, and overall company success. Committed to continuously developing and applying knowledge to effectively support organizational requirements and enhance functionality.
Overview
19
19
years of professional experience
Work History
Grievance and Appeals Specialist
CVS CAREMARK
06.2022 - Current
- Research and resolve member complaints ensuring compliance with Grievance and Appeals policies and procedures
- Maintain grievance and appeals case files in database
- Effectively communicate with members and providers verbally and in writing
- Prepare summaries and write resolution letters for members, which include summarizing member complaints and steps taken to resolve complaints in clear and grammatically correct language
Credentialing Coordinator
BroadPath
09.2023 - 08.2024
- Credential providers into Medicare
Infusion Coordinator Manager
Articularis Healthcare
09.2021 - 06.2022
- I supervised coordinators in inputing incoming prior authorizations, patient information, and eligibility data accurately and timely into the Electronic Medical Records (EMR) system
- I reviewed requests and clinical packets to ensure all necessary information is included and accurate
- I ensured verification of insurance benefits and prior authorization for each patient and secure predeterminations if prior authorizations have not been obtained
- I ensured prior authorization and pre-determination communications regarding status/receiving request and submitting appeal and peer-to-peer letters
- I maintain the online share file so all information is entered and current and accurate
- I ensured enrollment of patients with Pharmaceutical Copay Assist Programs per eligibility requirements
Provider Enrollment Specialist
Beacon Health Options
11.2016 - 09.2021
- Perform primary source verification of all credentialing requirements: education, training, experience, certification and licensing
- Verify provider state licenses, DEA certificates, malpractice insurance and any other expirable documents
- Communicate appointment, reappointment, clinical privileging decisions and changes to providers and internal/external parties, as required
- Access external databases to obtain required documents necessary to complete credentialing applications
- Populate, maintain and update credentialing database to ensure accountability for the integrity of the information entered in the system
- Research provider requests for demographic data maintenance to validate accuracy of change request and/or if more information may be needed
- Interact with provider to close information gaps where necessary
- Respond to provider inquiries (Network Assistance Form tickets) spanning several types of inquiries (ex: status of their application)
Provider Enrollment Manager
ValueOptions Federal Services, Inc
02.2006 - 11.2016
- Manage the provider application / onboarding process and workflow within internal systems, ensuring information is collected and documented against workflow standards
- Ensure all systems coordinate at all times
- Ensure accuracy of our provider applications, inquiry responses, and all corresponding data by engaging in related review and audit processes
- Keep inventory on all system, contractual, compliance standard and policy change
- Accurately process newly credentialed, re-credentialed and terminated providers updates
- Independently plan, organize and complete tasks successfully for team members 8+
- Obtained accurate verification of provider demographic information for monthly APD reporting with audits, verifications, and obtaining information needed for credentialing process as needed
- I was responsible for achieving production volume standards as defined by department management, and I focused on specific aspects of the provider application / inquiry / data integrity processes (as defined by management)
Education
Associates - Science
Jacksonville State College
Jacksonville, FLGeorgetown High School -
Georgetown High School
Georgetown, SC01.1998
Skills
- EMR Systems
- Epic
- ICD-10
- Insurance Verification
- Medical Records
- Triage
- Data Analysis
- Medical Coding
- ICD-9
- Medical Scheduling
- Medical Billing
- Employee Orientation
- CPT Coding
- Transcription
- Patient Care
- Hospital Experience
- Customer service
- Microsoft Word
- Microsoft Excel
- Microsoft Outlook
- Microsoft Office
- Communication skills
- Organizational skills
- Analysis skills
- HCPCS
- Supervising experience
- Documentation review
- Inpatient
- Pivot tables
- Employment & labor law
- Negotiation
Personal Information
Work Permit: Authorized to work in the US for any employer
Assessments
Supervisory skills: Motivating & assessing employees, Proficient, 11/20
Timeline
Credentialing Coordinator
BroadPath
09.2023 - 08.2024
Grievance and Appeals Specialist
CVS CAREMARK
06.2022 - Current
Infusion Coordinator Manager
Articularis Healthcare
09.2021 - 06.2022
Provider Enrollment Specialist
Beacon Health Options
11.2016 - 09.2021
Provider Enrollment Manager
ValueOptions Federal Services, Inc
02.2006 - 11.2016
Georgetown High School -
Georgetown High School
Associates - Science
Jacksonville State College
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