Leslie Caston
Madison
Summary
Detail-oriented Provider Credentialing Consultant with a proven track record in streamlining verification processes and ensuring HIPAA compliance. Skilled in managing multiple projects and enhancing provider relations.
Results-driven professional with extensive experience in provider credentialing and relations. Known for effective communication and problem-solving skills, consistently achieving faster onboarding and increased provider satisfaction. Committed to maintaining compliance with industry regulations.
Diligent [Desired Position] with comprehensive background in provider credentialing. Proven track record of ensuring compliance and streamlining credentialing processes to meet organizational standards. Demonstrated proficiency in data management and relationship-building with healthcare providers.
Experienced with credentialing healthcare providers and maintaining compliance across various regulatory standards. Utilizes data management and analytical skills to enhance credentialing accuracy and efficiency. Track record of building effective relationships with healthcare providers and team members.
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Pursuing full-time role that presents professional challenges and leverages interpersonal skills, effective time management, and problem-solving expertise.
Overview
12
12
years of professional experience
Work History
Provider Credentialing Consultant
Medica (Dean) / Spherion Staffing Agency
Madison, WI
05.2023 - Current
- Evaluated provider credentials to ensure compliance with state and federal regulations.
- Streamlined verification processes, enhancing accuracy and reducing turnaround time for credentialing.
- Collaborated with cross-functional teams to resolve discrepancies in provider documentation.
- Achieved faster provider onboarding by collaborating with cross-functional teams to ensure timely completion of tasks.
- Reduced credentialing delays by proactively identifying potential issues and addressing them promptly.
- Collaborated with medical staff services to streamline communication and facilitate a smooth credentialing experience for providers.
- Maintained confidentiality by adhering strictly to HIPAA guidelines during the handling of sensitive provider information.
- Continuously updated personal knowledge on state licensing boards'' requirements, enabling accurate guidance regarding licensure processes for healthcare professionals across states.
- Conducted thorough audits of credential files to identify gaps or inconsistencies, leading to an overall increase in accuracy and reliability of provider data.
- Managed multiple projects simultaneously, prioritizing tasks effectively to meet strict deadlines within a fast-paced environment.
- Obtained NPI numbers for providers and facilities and updated existing profiles.
Provider Relations Specialist
Assurance SD
Madison, WI
10.2023 - 03.2025
- Facilitated communication between providers and internal teams to enhance collaboration and service delivery.
- Analyzed provider feedback to identify trends and implement strategic improvements in service processes.
- Developed training materials for onboarding new providers, ensuring alignment with organizational standards.
- Collaborated with cross-functional teams to resolve provider issues efficiently, enhancing overall satisfaction.
- Led workshops to educate providers on new policies and procedures, increasing their engagement and compliance.
- Answered provider inquiries via email, telephone and written correspondence.
- Managed provider relations mailbox by triaging inquiries, facilitating resolution of incoming requests and forwarding requests to appropriate parties.
- Contributed to and enhanced audit processes to maximize quality management standards.
- Increased provider satisfaction scores [Number]% by collecting and credentialing demographic updates, investigating claims and inquiries and overseeing network integrity.
- Brought in [Number] new providers to enhance coverage and meet program goals.
- Streamlined provider onboarding process, reducing time to complete required documentation.
- Provided expertise on labor and employment laws to help employers make more effective decisions.
Customer Support Specialist
Gainwell Technologies
Madison, WI
03.2023 - 07.2023
- Resolved customer inquiries through effective communication and problem-solving techniques.
- Managed multiple support channels, ensuring timely responses to client requests.
- Collaborated with cross-functional teams to enhance customer experience and satisfaction.
- Trained new team members on best practices for customer interaction and support systems.
- Developed strong relationships with clients, resulting in repeat business and positive feedback.
- Delivered exceptional customer service experiences by maintaining a positive attitude, active listening skills, and empathetic responses to customer concerns.
- Managed a high volume of inbound calls while maintaining excellent call quality standards and adhering to established procedures.
- Enhanced customer satisfaction by addressing and resolving complex issues promptly and professionally.
- Provided timely assistance to customers via phone, email, and live chat channels, ensuring a high level of professionalism at all times.
- Handled escalated support cases with diplomacy and tact, successfully defusing tense situations between the company and its customers.
- Maintained thorough knowledge of product offerings to provide accurate information and expert advice to customers.
- Multitasked to handle diverse customer needs in high-volume [Type] setting, prioritizing tasks to keep up with challenging deadlines.
Insurance Claims Representative
QBE
Sun Prairie, WI
05.2014 - 12.2022
- Evaluated and processed insurance claims to ensure compliance with policy terms.
- Collaborated with clients to gather necessary documentation for claim validation.
- Analyzed claim data to identify discrepancies and potential fraud indicators.
- Provided expert guidance on claim procedures to enhance customer understanding.
- Improved customer satisfaction by efficiently handling insurance claims and providing timely resolutions.
- Utilized industry-specific software to track claims status and maintain records effectively.
- Analyzed financial data related to claims expenses, making recommendations for cost-saving measures where applicable.
- Maintained a strong knowledge of industry regulations, ensuring compliance in all claims management activities.
- Managed complex cases requiring arbitration or litigation support by collaborating closely with legal counsel.
- Expedited claim payments by effectively managing workload priorities and keeping accurate documentation records.
- Developed strong working relationships with fellow team members, fostering a supportive environment that promoted productivity.
- Provided exceptional customer service to policyholders, addressing concerns and answering questions throughout the claims process.
- Generated, posted and attached information to claim files.
Education
Human Services
University of Phoenix
Tempe, AZSkills
- Provider enrollment
- Regulatory research
- Audit preparation
- Healthcare regulations
- Credential verification
- License monitoring
- Credentialing software proficiency
- Recredentialing processes
- Insurance procedures
- HIPAA compliance
- Document review
- Provider relations
- Proofreading
- License verifications
- Credentialing documentation
- Facility credentialing
- Willingness to learn
- Teamwork
- Problem-solving
- Time management
- Attention to detail
- Problem-solving abilities
- Multitasking
- Reliability
- Excellent communication
- Active listening
- Effective communication
- Microsoft office
- Self motivation
- Interpersonal skills
- Professionalism
- Organizational development
Timeline
Provider Relations Specialist
Assurance SD
10.2023 - 03.2025
Provider Credentialing Consultant
Medica (Dean) / Spherion Staffing Agency
05.2023 - Current
Customer Support Specialist
Gainwell Technologies
03.2023 - 07.2023
Insurance Claims Representative
QBE
05.2014 - 12.2022
Human Services
University of Phoenix