Marsida Kaliqi
Philadelphia,PA
Summary
Highly Efficient Healthcare Specialist with 8 Years Experience in different sectors of healthcare with exemplary time management and organizational skills. Knowledgeable in diverse medical evaluation and treatment methods. Adept at performing and focusing attention under pressure. Ambitious individual who is looking to advance career in the Pharmaceutical industry.
Overview
5
5
years of professional experience
Work History
PROVIDER ENROLLMENT COORDINATOR
Children's Hospital of Philadelphia, CHOP
Philadelphia, PA
06.2021 - Current
- Verified provider credentials with licensing boards and other regulatory bodies to ensure compliance with applicable standards.
- Researched and resolved discrepancies in enrollment applications.
- Processed new provider applications and requests for changes to existing providers.
- Communicated regularly with providers, payers, and internal teams regarding the status of their applications.
- Monitored completion of required documents from providers prior to submitting them for processing.
- Developed relationships with vendors who provide services related to the enrollment process.
- Submitted timely updates on pending enrollment applications to management team.
- Maintained accurate records of all provider enrollments and re-enrollments.
- Analyzed data from multiple sources including Medicare and Medicaid websites, databases.
- Ensured that all documentation was up-to-date according to federal regulations.
- Facilitated communication between payers, providers, government agencies.
- Collaborated with internal departments such as billing, customer service, compliance.
Account Representative
Children's Hospital of Philadelphia, CHOP
Philadelphia, PA
07.2019 - 06.2021
- Provided excellent customer service to ensure client satisfaction.
- Resolved customer complaints in a timely manner.
- Maintained detailed records of all client communications.
- Responded quickly to customer inquiries via phone or email.
- Maintained accurate and complete records on past due accounts and collection actions.
- Developed and maintained solid client relationships by regularly following up on clients.
- Set up and updated customer accounts with interactions, payments and personal information.
- Served as primary contact and support for maintaining account information and opening and closing accounts.
- Reviewed and processed incoming claims for accuracy and completeness.
- Analyzed claim information to determine the appropriate course of action.
- Verified insurance coverage and benefits prior to processing claims.
- Submitted claims electronically or via paper format as required.
- Followed up on denied or rejected claims to resolve issues quickly.
- Provided assistance in developing new processes and policies related to claim processing.
- Adhered strictly to HIPAA guidelines when handling confidential patient information.
Medical Case Specialist
QTC Management Inc, A Leidos Co
Philadelphia, PA
11.2018 - 06.2019
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Displayed strong telephone etiquette, effectively handling difficult calls.
- Exceeded customer satisfaction by finding creative solutions to problems.
- Identified needs of customers promptly and efficiently.
- Assisted with customer requests and answered questions to improve satisfaction.
- Verified patient's demographic information and updated records accordingly.
- Scheduled appointments, managed calendars and ensured accuracy of appointment times.
- Entered patient data into the electronic health record system accurately and timely.
- Ensured HIPAA compliance by keeping all patient information confidential.
- Coordinated referrals between primary care physicians and specialists.
Education
Bachelor of Science - Healthcare Administration
Peirce College
Philadelphia, PA05-2020
Associate of Applied Science - Healthcare Management
Community College of Philadelphia
Philadelphia, PA05-2014
Skills
- Software troubleshooting
- Claims Processing
- Workflow Optimization
- Report Generation
- HIPAA Compliance
- Insurance Verification
- Provider Relations
- Understanding of customer support
- Time management proficiency
- Record maintenance
- Cross-Functional Teamwork
- Telephone and email skills
- Billing support
- Documentation Management
- Data entry skills
- Strong Organization
Languages
Albanian
Full Professional
References
References available upon request.
Timeline
PROVIDER ENROLLMENT COORDINATOR
Children's Hospital of Philadelphia, CHOP
06.2021 - Current
Account Representative
Children's Hospital of Philadelphia, CHOP
07.2019 - 06.2021
Medical Case Specialist
QTC Management Inc, A Leidos Co
11.2018 - 06.2019
Bachelor of Science - Healthcare Administration
Peirce College
Associate of Applied Science - Healthcare Management
Community College of Philadelphia