Morgan Makowski
Buffalo,NY
Summary
Credentialing professional with a proven track record in managing credentialing operations and ensuring compliance. Exceptional experience in data management and analysis; demonstrating attention to detail and strategic planning to improve workflow. Valued for collaboration and achieving results. Known for adaptability and reliability in dynamic environments with expertise in documentation and regulatory standards.
Overview
10
10
years of professional experience
Work History
Credentialing Specialist
Symplr
05.2024 - Current
- Follow NCQA, TJC guidelines and requirements
- Conduct thorough primary source verification for healthcare provider credentials
- Manage and update provider databases to ensure compliance with regulatory standards
- Review and analyze documentation for accuracy and completeness in credentialing applications
- Contribute positively to team dynamics by fostering a collaborative and supportive work environment
- Address and resolve discrepancies in provider documentation, maintaining a high level of data integrity
Credentialing Specialist
Highmark BCBS
11.2017 - 05.2024
- Receive, process, and verify initial and re appointment medical provider applications in a timely manner
- Analyze and verify accuracy, eligibility, and compliance with both business, NCQA, and DOH policy and procedures
- Adhere to state bylaws and regulations
- Obtain primary source verification from NPDB, CAQH, state and federal government websites
- Create tracking systems via databases and spreadsheets to monitor the status of applications
- Research to ensure the provider is enrolled in the proper networks
- Efficiently and effectively communicate with physicians and medical office staff
- Contribute ideas and solutions to increase efficiency/quality of overall process
- Report noticeable problems preventing timely production and work flow
Customer Service Representative
Highmark BCBS
05.2016 - 11.2017
- Build and maintain a business relationship with members by creating a foundation of trust and first call resolution
- Assist members with various inquiries regarding eligibility, benefits, and claims
- Inform members of insurance plans and options using databases such as PEGA, Streamline, and Facets
- Display strong organizational skills while handling multiple projects simultaneously
- Meet daily customer service quotas with a focus on quality
- Analyzed customer feedback to identify trends, informing process improvements and service enhancements
Education
Bachelor of Science - Business Management
Buffalo State College SUNY
Buffalo, NY05-2016
Skills
- Data Analysis
- HIPAA compliance
- Quality Assurance
- Time Management
- Customer Service
- Process Improvement
- Provider Relations
- Organizational Skills
- Strategic Planning
Timeline
Credentialing Specialist
Symplr
05.2024 - Current
Credentialing Specialist
Highmark BCBS
11.2017 - 05.2024
Customer Service Representative
Highmark BCBS
05.2016 - 11.2017
Bachelor of Science - Business Management
Buffalo State College SUNY