Lisa Shirk

• Provided personal care assistance to enhance daily living activities for clients.
• Developed and maintained trusting relationships with clients and families for improved emotional support.
• Assisted clients with mobility and transportation to ensure access to essential services.
• Monitored health status and reported changes to healthcare professionals for timely interventions.

Assisted with provider phone calls for denied and appealed claims and reprocessed when needed.

Reprocessed voided checks that were stale dated.

Adjudicated claims.

• Collaborated with healthcare providers to gather necessary information for accurate credentialing decisions.
• Enrolled providers and Medicaid, Medicare, and private insurance plans.
• Conducted primary source verifications such as background checks and board certifications.
• Safeguarded confidential provider information by adhering to strict data privacy regulations and company policies.
• Received and evaluated applications to look for missing and inaccurate information.
• Obtained NPI numbers for providers and facilities and updated existing profiles.
• Expedited the onboarding process for new providers, ensuring timely completion of all required documentation and verifications.
• Conducted comprehensive credentialing assessments for healthcare providers to ensure compliance with industry standards.
• Streamlined provider enrollment processes, enhancing efficiency and reducing turnaround times for credentialing approvals.
• Reduced errors in credentialing files by conducting thorough reviews and consistently maintaining attention to detail.
• Streamlined provider credentialing process, significantly reducing wait times for new provider onboarding.

• Printed EOBs and workers comp notes for different insurance companies and mailed them.
• Submitted claims for patients online for PSV electronically.
• Processed credit card payments
• Processed outgoing mail

• Completed enrollments for Medicare and private insurance plans for providers.
• Made phone calls to commercial and Medicaid insurance companies for patients' eligibility and benefits.
• Entered claims through a Clearing House called Open Practice Solutions and Availity.
• Posted payments in Open Practice Solutions.

• Reviewed CAQH applications for credentialing and re-credentialing ensuring accuracy, completeness, and compliance with all accreditation standards.
• Validated primary source documents such as licenses, diplomas, certifications and other related credentials.
• Maintained detailed records of provider data in the credentialing database system.
• Ensured timely completion of credentialing processes by guidance to providers on required documentation.
• Conducted background checks for potential providers utilizing various resources including state licensing boards, OIG, GSA Exclusion List, and NPDB.
• Completed enrollment for Medicare and private insurance plans for providers.
• Primary source documents that were due for renewal, reached out to provider via email to ensure renewals were done within the required protocol.
• Updated current profile information for NPI numbers.