Michelle Teart
Tenino,WA
Summary
Highly motivated Credentialing Specialist. I have a history of meeting company needs with consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the company.
Overview
7
7
years of professional experience
Work History
Credentialing Specialist and Billing Manager
Comprehensive Care Services
Plymouth, MI
01.2021 - 01.2024
- Developed and implemented billing procedures to ensure accurate data entry and timely payment collection.
- Participated in process improvement initiatives to increase efficiency within the department.
- Set up and maintained Tebra electronic billing system.
- Created and updated financial reports on frequent basis to present information to leadership teams.
- Completed enrollments into Medicaid, Medicare and private insurance plans.
- Reviewed and processed credentialing applications to ensure accuracy, completeness, and compliance with all accreditation standards.
- Scheduled or conducted new employee orientations.
- Familiarity with working the entire contracting process from start to finish.
- Submitted initial and re-credentialing enrollment applications for Medicaid, Medicare and commercial insurance.
- Responsible for the accuracy of supporting documentation for contracts and completing documents accurately.
- Enrolled medical providers and groups in both in and out of network commerical insurance plans.
- Maintained and updated organizational charts, employee handbooks or performance evaluation forms.
- Ensured timely completion of credentialing processes by providing guidance to providers on required documentation.
- Selected qualified job applicants or referred to managers to make hiring recommendations.
- Maintained informational resources, tracking and documenting requests for updates, certification and credentialing.
Credentialing Specialist and Human Resource Admin
Northwest Monitoring
Gig Harbor, WA
11.2018 - 12.2020
- Oversaw the benefits enrollment process by answering questions and assisting employees with details.
- Managed payroll for over 33 hourly and salaried employees.
- Kept operations in compliance with requirements by applying knowledge of applicable regulations, legal statutes and tax code information.
- Calculated overtime, vacation sick hours and other categories of time.
- Applied comprehensive understanding of HR principles and employment laws and regulations to provide counseling to and develop policies.
- Managed recurring HR processes such as onboarding new staff.
- Developed process improvements and streamlined procedures to effectively resolve employee discrepancies.
- Created job descriptions to attract targeted talent pool within market wage range.
- Discussed medical, dental, short-term and long-term benefit plans with new hires and eligible employees with status changes.
- Conducted new hire orientations making new employees feel welcome and ready to succeed.
- Set up NPI numbers for providers and facilities and updated current profile information.
- Developed reports related to provider demographic information, status changes, verifications completed, as requested by management or external customers.
- Completed enrollments into Medicaid, Medicare and private insurance plans.
- Reviewed and processed credentialing applications to ensure accuracy, completeness, and compliance with all accreditation standards.
- Prepared or maintained employment records using human resources management system software.
- Processed re-credentialing applications for existing providers according to contractual requirements.
Provider Service Coordinator
Deer Oaks Mental Health Associates
San Antonio, TX
10.2016 - 08.2018
- Answered questions and responded to inquiries to deliver high level of service to mental health providers.
- Completed various reports and analyzed each report to decide where improvements could be made.
- Worked closely with team members to deliver project requirements, develop solutions and meet deadlines.
- Sought clarification from physicians for answers to any needed coding interpretations prior to abstracting records.
- Reviewed all claims for accurateness and appropriateness.
- Verified final claim submissions by comparing account charges with documentation.
- Reviewed medical records to meet insurance company requirements.
- Maintained accurate and timely charge submissions utilizing electronic charge capture practices, including billing and account receivables (BAR) system and medical billing clearinghouse accounts.
- Applied HIPAA Privacy and Security Regulations while handling patient information.
Education
Master of Arts - Developmental Psychology
Liberty University
Lynchburg, VA06-2016
Bachelor of Arts - Developmental Psychology
University of Washington
Tacoma, WA06-2004
Skills
- Staff Management
- Process Improvement
- Project Planning
- Policy Administration
- Research, interpret, and clarify rules, regulations, and policies
- Knowledge of CAQH, PECOS and NPPES websites
- Able to self-direct and work independently
- Exceptional organizational skills
- Excellent ability to pay close attention to detail and multi-task
- Performance Evaluations
- Employee Coaching and Mentoring
- MS Office
- Provide creative, responsive, high-quality technical advice and consultation
Timeline
Credentialing Specialist and Billing Manager
Comprehensive Care Services
01.2021 - 01.2024
Credentialing Specialist and Human Resource Admin
Northwest Monitoring
11.2018 - 12.2020
Provider Service Coordinator
Deer Oaks Mental Health Associates
10.2016 - 08.2018
Master of Arts - Developmental Psychology
Liberty University
Bachelor of Arts - Developmental Psychology
University of Washington
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