Lisa Shirk
East Hampton,CT
Summary
Seasoned Credentialing Specialist lends 10 + years of success overseeing complex information access policies and procedures. Effective documentation to maintain threshold requirements. Detail-oriented processing for status-change requests and assessments. Hands-on approach to handling requests-for-access and information credentialing.
Overview
15
15
years of professional experience
Work History
Credentialing Specialist
Medi Claims Connection
North Haven, CT
05.2019 - 09.2020
- Completed enrollments into Medicare and private insurance plans for providers.
- Made calls to commercial insurance companies for patients eligibility and benefits.
- Billed claims through Open Practice Solutions and Availity.
- Medicaid authorizations for patients
- Posted payments in Open Practice Solutions
Credentialing Specialist
MedOptions Inc.
Old Lyme, CT
06.2016 - 06.2019
- Completed enrollments in Medicare and private insurance plans.
- Performed primary source verifications such as criminal histories, licenses and board certifications.
- Checked CAQH applications for missing information and organized all paperwork.
- Completed applications for clinicians for nursing homes in which they were assigned to work there.
- Processed applications for credentialing with NCQA standards specifications
Housekeeper
Evergreen Woods
Branford, CT
07.2013 - 06.2016
- Swept and vacuumed floors and hallways.
- Responsible each day for cleaning a wing in the Health Center that had 22 rooms.
- Talked to patients in each room while cleaning and showed respect and compassion.
- Played the piano in the health center a couple of days during the week after my shift ended.
- Cleaned and returned vacant rooms to occupant-ready status.
- Collected trash from premises and removed to designated areas to alleviate bad odors.
Private Caretaker for Elderly Gentleman
Self
East Haven, CT
05.2011 - 07.2013
- Prepared food and helped to support healthy nutrition.
- Washed and folded laundry
- Light house keeping
- Participated in different community activities with client
Therapeutic Mentor
Inclusion First LLC
Canton, CT
06.2005 - 09.2011
- Documented client behaviors and functional levels for clients.
- Helped eliminate inappropriate behaviors and manage triggering events.
- Assisted with identifying behavioral goals and implementing interventions.
- Encouraged participation in social integration activities.
- Supported individuals one-on-one in line with treatment plan and individual emotional needs.
- Wrote goals for each client and progress reports on the progress of those goals. Once goals were reached I would establish more goals for the clients.
- Earned reputation for good attendance and hard work.
- Mostly worked with young children from age 5 to 14 and worked with 2 grown adults who all had different types of disabilities such as autism, non-verbal communication, and separation anxiety from parents.
Credentialing Specialist
Healthnet
Shelton, CT
11.2007 - 03.2011
- Demonstrated high level of credentialing turn around times/36 months from previous committee meetings to complete re-credentialing. Initial credentialing completed within 52 days of receipt of a completed application
- Met compliance with Health Net standard of participation with company and compliance with regulatory and accreditation such as NCQA, CMS, etc.
- Had general understanding of medical terminology
- Determined eligibility for providers and troubleshoot all steps throughout the processing of each application for completeness and compliance
- Accurately filed and ensured files were prepared for credentialing, mailing, and scanning
- Communicated with providers by phone and mail regarding their credentialing status and if additional information was needed to finish processing their application.
Education
Associate of Science - Applied Science
Shelton State Community College
Tuscaloosa, AL11.1987
Skills
- Facility credentialing
- License verifications
- Insurance billing
- Customer service
- Problem resolution
- Team building
- Solo practitioner credentialing
Timeline
Credentialing Specialist
Medi Claims Connection
05.2019 - 09.2020
Credentialing Specialist
MedOptions Inc.
06.2016 - 06.2019
Housekeeper
Evergreen Woods
07.2013 - 06.2016
Private Caretaker for Elderly Gentleman
Self
05.2011 - 07.2013
Credentialing Specialist
Healthnet
11.2007 - 03.2011
Therapeutic Mentor
Inclusion First LLC
06.2005 - 09.2011
Associate of Science - Applied Science
Shelton State Community College
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