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Open to workDesired start date: Immediately
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Megan D. Embrey
Hermitage,USA
Work Preference
Summary
Accomplished healthcare professional with over 15 years of experience in the healthcare industry that will give me the opportunity to continue educating myself in the health care field. A detail oriented and energetic team player who is capable of working on own initiative along with ability to produce accurate work. I am looking to build upon my experience and knowledge in healthcare in order to move forward professionally based on my consistent achievements.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Credentialing Coordinator
Vanderbilt University Medical Center
2020.08 - Current
- Perform and collect PSV (primary source verification) documentation for licensing, board certifications, proof of malpractice insurance and claim history
- Request NPDB report via SProvider
- Verify education via AMA
- Verify if the provider is credential with current or previous work history
- Maintain working knowledge of the National Committee on Quality Assurance (NCQA) standards and State and Federal regulations related to credentialing
- Credential initial and recredential providers through Symplr Provider
- Performs primary source verification for providers
- Run affiliation letters through different healthcare institutions websites
- Maintain the credentialing database via Cactus and ensure up-to-date information is obtained
- Ensures appropriate documentation is maintained and that information is easily retrievable
Credentialing Coordinator
Acadia Healthcare
2020.03 - 2020.08
- Prepare and submit initial and re-credentialing documentation
- Track and monitor incoming and outgoing credentialing requests, including maintenance of credentialing files
- Maintain various database systems (VerityStream and UltiPro)
- Prepare and submit Medicaid enrollments and re-validations
- Work directly with the Contracting Department to resolve disputes
- Prepare and administer routine correspondence, memoranda and notifications
- Work closely with the Contracting Department to ensure efficiency of processes and create new workflow tools as needed
- Update and maintain in-house documents
- Ensure accuracy of providers credentials by doing primary source verification of state license, DEA, board certification etc.
- Add new clinics and providers in VerityStream as needed
- Track and validate documents in Data Validation Grid
Provider Enrollment Specialist
American Physician Partners
2019.06 - 2020.03
- Knowledge of PECOS by submitting 855I and 855R applications.
- Submit enrollment applications for Ohio, Michigan, Tennessee and Virginia.
- Update and upload documents that are expired in CAQH
- Add practice locations in CAQH
- Maintain the active roster for the Provider Enrollment Facilities when enrolling the provider with the payor.
- Receive emails from CAQH to update and re-attest the provider’s profile.
- Contact the credentialing department to request items that are needed to enroll the providers with the payors.
- Create and maintain proper tracking/workflow in the Provider Enrollment software application EchoOneApp.
- Review correspondences received from the payors and providers and perform appropriate action to resolve.
- Appropriately resolve or escalate payor application denials.
- Updating the SOPs (Standard Operating Procedures) for Michigan, Tennessee and Virginia.
- Maintain working knowledge of workflow, systems and tools used in the department.
Treasury Specialist
HCA Physician Services Group
2018.03 - 2019.06
- Reviewing DPRs (Daily Practice Reconciliation) reports for posting accuracy to patient accounts, deposit receipts, credit card receipts, and end of day payment reports.
- Provide support to other cash management departments for accuracy on lockbox, EFT, and ERA payment postings.
- Provide support to the accounting department during the end of month close.
- Research deposit vs posted items for adjustments/corrections to patient accounts
- Assist practice support in transferring/correcting patient payments
- Research items for accuracy using HCA Enterprise Analytics Library (HEAL) that includes Payment Batch Detail and Receipt Summary
- Experience working with various software programs, (ecW launcher, Dashboard, Cash Management Tool, OnBase, CashPro, and Treasury Tool)
Payor Response Specialist
Electronic Data Interchange (EDI)
2017.06 - 2018.03
- Perform claim research and analysis to resolve payor responses (i.e. 276/277 Transactions and 835/Explanation of Benefit (EOB) Claim Adjustment Reason (CAS) codes) in accordance with department policies and procedures
- Initiate telephone calls to payors with respect to claim errors, provider enrollment, patient eligibility and claim status, utilizing proper customer service protocol
- Review correspondence received and performed appropriate action resolve
- Meet and maintain established departmental metrics for production 95% and quality
- Maintain working knowledge of workflow, systems and tools used in the department
- Looking up a patient and provider information via Artiva 4.0 to see about a claim review
- Knowledge of Relay Health to look up claims to see if there is an EOB and the reason why the claim was denied
- Knowledge of ECW (eClinicalWorks) to find the patient’s insurance card to see if it matches what is in the payer website
Provider Enrollment Application Process Representative
2016.06 - 2017.06
- Processed all new and established provider/group Payor applications in Cactus software
- Updated Provider/Payor records in Cactus software.
- Maintained the accuracy of provider’s information in CAQH Proview.
- Used Outlook to establish close working relationships with credentialing coordinators and Payor contacts to request additional information and/or send the necessary documents to get the providers enrolled.
- Understand specific application requirements for each Payor including pre-requisites, forms required, form completion requirements, supporting documentation (DEA, CV, etc.), and regulations.
- Created spreadsheets with the use of Excel to follow up on the providers.
- Maintained providers’ demographic updates have been changed.
- Used OnBase Application to retrieve mail; saved corresponding emails and provider enrollment applications.
- Sent out notification letters to Payors on demographic changes (ex. Add location; term location; address changes; term from Tax ID).
- Reached and maintain established departmental metrics for production 100% and quality
Provider Enrollment Specialist
Comprehensive Pain Specialists (CPS)
2015.11 - 2016.04
- Set up and maintain provider information in online credentialing software SyMed Echo OneApp Pro.
- Performed follow-up with the payers as needed to research and resolve provider enrollment issues.
- Performed follow-up with insurance payers via phone, email or website to resolve provider enrollment issues.
- Managed the completion and submission of provider enrollment applications.
- Performed tracking and follow-up to ensure provider numbers are established and linked to the appropriate group entity in a timely manner.
- Understand specific application requirements for each payer including pre-requisites, forms required, form completion requirements, supporting documentation (DEA, CV, etc.), and regulations.
- Maintained documentation and reporting regarding provider enrollments in process.
- Retained records related to completed provider enrollments.
- Established close working relationships with credentialing coordinators, contracting department, medical management, and payer contacts.
- Assisted with a variety of special projects such as finding out the requirements to enroll in a physician owned lab with the payer.
- Performed other duties as assigned.
Provider Enrollment Specialist
Community Health Systems (CHS)
2015.02 - 2015.11
- Communicated to the designated contact person of the needed paperwork necessary to begin application process for new practitioners
- Researched to gather all details to appropriately enroll the practitioner
- Obtain completed “Notification Form” from the practitioner contact for every practitioner for which services are requested
- Input and retrieve data in the credentialing/provider enrollment system VISTAR within a required timeframe
- Obtain copy of CHS provider contact which notes the employer and type of contact arrangement
- Obtain checklist items in a timely manner for each practitioner
- Maintain contact with designated contact person to obtain application signatures, and collect all required attachments to include with completed applications
- Input provider enrollment information and scan all related enrollment documents into CARE-Newport Credentialing Solutions
- Contact insurance plans to request provider enrollment application packages
- Follow-up with insurance plans by telephone or email until all provider numbers are issued
- Maintain physician CARE records in proper manner by scanning copies of all correspondence, linking documents to the appropriate payer screen and documenting notes in payer screen note fields
- Prepare and distribute “Provider Grid” to designated contact person for each provider to communicate the progress of approved provider numbers. Ensure the Provider Grid is prepared and distributed each time and update occurs
- Perform re-credentialing for providers as needed
- Complete applications for new acquisitions
- Complete applications for Medicare, Medicaid, Fee for Service and Commercial enrollment
- Use of PECOS to complete Medicare applications
- Complete required forms and applications for changes in billing systems
Senior Credentialing Coordinator
Corizon Health
2007.05 - 2015.01
- Overseen the dispensing of credentials for the practitioners, nurse practitioners and physician assistants of a correctional healthcare organization
- Responsible for coordinating, monitoring and maintaining the credentialing and re-credentialing process
- Compiled and maintained current and accurate data for all providers
- Checked certifications and licenses, and made sure all credentials are current
- Distributed a monthly expired credentialing report to the executives and other healthcare employees to assess the credentials that are overdue and will expire in the next 30 days
- 7 years of experience NCQA policies and procedures
- Scheduled and supported (prepares agenda, attends and prepares minutes) the Credentialing Committee
- Input the practitioners and mid-levels information into the MD Staff software
- Scanned application and credentials in the practitioners and mid-levels folder
- Monitored status of pending credentials
- Followed up to obtain missing information as needed
Externship
Cimplify
2009.07 - 2009.09
- Attached primary explanation of benefits (EOB’s) to secondary claims
- Adjust Medicare payments to patients’ accounts through Misys Vision/Optimum 8.0
- Called insurance companies to check status of patient’s claims
- Looked up EOB’s through CIMVIEW
- Input the status of patients’ claim on the procedure code through Misys Vision/Optimum 8.0
Charge Entry Coordinator/Cash Application Specialist
Howell Allen Clinic
2005.10 - 2007.05
- Performed cash application functions relevant to patient financial services
- Balanced control logs and daily deposits
- Accurately identifies and posts payment and adjustment transactions to patient accounts, client accounts, and to the general ledger
- Posted electronic remits from third party payers to the patient accounting system
- Completed control log and balancing receipts for bank deposit; Verified patients’ insurance and payments through Misys PM
Medical Receptionist
Dr. Ronald McFarland M.D. & Dr. Everton Arrindell M.D
2001.08 - 2005.10
- Checked in and outpatients
- Posted charges to patients’ accounts and billed to correct insurance
- Verified patients’ insurance coverage through use of the Passport
- Performed clerical duties to facilitate efficient flow in the front office
- Obtained referrals of incoming patients; Knowledge of Medic/Medware practice management system
- Recorded accurate messages and relay to proper parties
- Scheduled, rescheduled and confirm appointments for in-office visits
- Prepared new patient charts and updated patient information
- Filed correspondence of patients’ information (i.e., referral letters, lab operative reports, ect). Answered multi-line phone system
Education
Medical Billing and Coding Program -
Kaplan Career Institute
Nashville, Tennessee2009-09
MBA/HealthCare Management - undefined
University of Phoenix
Nashville, Tennessee2005-03
B.B.A./Business Information System - undefined
Tennessee State University
Nashville, Tennessee2001-12
Associate Degree/Business Administration - undefined
Sinclair Community College
Dayton, Ohio1999-06
Skills
- Significant healthcare credentialing experience
- Team player
- Accurate and efficient
- Detail-oriented and well-organized
- Research and analyze data
- Prioritize work and manage multiple assignments
- Maintain effective working relationships
- Proficient use of Microsoft Office applications
- CACTUS
- Artiva 40
- Relay Health
- EClinicalWorks (ECW)
- Vistar
- PECOS
- Echo OneApp
- UltiPro
- OnBase
- Medic/MedWare
- SyMed OneApp Pro
- MD-Staff
- CARE-Newport Credentialing
- CAQH
- VerityStream
- SProvider (Symplr Provider)
- Effective written and verbal communication
Certification
- CPR Certified American Heart Association
- Health Insurance Portability and Accountability Act (HIPAA) trained
- Medical Law and Ethics
Timeline
Credentialing Coordinator
Vanderbilt University Medical Center
2020.08 - Current
Credentialing Coordinator
Acadia Healthcare
2020.03 - 2020.08
Provider Enrollment Specialist
American Physician Partners
2019.06 - 2020.03
Treasury Specialist
HCA Physician Services Group
2018.03 - 2019.06
Payor Response Specialist
Electronic Data Interchange (EDI)
2017.06 - 2018.03
Provider Enrollment Application Process Representative
2016.06 - 2017.06
Provider Enrollment Specialist
Comprehensive Pain Specialists (CPS)
2015.11 - 2016.04
Provider Enrollment Specialist
Community Health Systems (CHS)
2015.02 - 2015.11
Externship
Cimplify
2009.07 - 2009.09
Senior Credentialing Coordinator
Corizon Health
2007.05 - 2015.01
Charge Entry Coordinator/Cash Application Specialist
Howell Allen Clinic
2005.10 - 2007.05
Medical Receptionist
Dr. Ronald McFarland M.D. & Dr. Everton Arrindell M.D
2001.08 - 2005.10
MBA/HealthCare Management - undefined
University of Phoenix
B.B.A./Business Information System - undefined
Tennessee State University
Associate Degree/Business Administration - undefined
Sinclair Community College
Medical Billing and Coding Program -
Kaplan Career Institute