Naje Crawford
Norfolk,Va
Summary
Detail-oriented Billing Coordinator with extensive experience in healthcare, adept at managing insurance claims and ensuring compliance with confidentiality standards. Proven ability to streamline billing processes and enhance patient care through efficient coordination. Recognized for reliability and a results-driven approach.
Overview
5
5
years of professional experience
Work History
Utilization Management/Billing Coordinator
GHR Center of Addiction
02.2024 - Current
- Perform comprehensive reviews of medical records to determine the appropriateness and necessity of healthcare services provided
- Utilize evidence-based guidelines and clinical criteria to assess the medical necessity and efficiency of treatments and services
- Collaborate with healthcare providers to ensure the delivery of quality care while optimizing resource utilization
- Conduct pre-authorization and concurrent reviews to evaluate the medical necessity of proposed treatments and procedures
- Analyze data and trends to identify opportunities for improvement in utilization patterns and healthcare outcomes
- Communicate with insurance providers and other stakeholders to facilitate authorization processes and resolve utilization issues
- Develop and implement strategies to promote cost-effective care and mitigate unnecessary utilization of healthcare resources
- Educate healthcare providers and staff on utilization management principles and best practices
- Maintain accurate documentation of utilization review activities and decisions in accordance with regulatory requirements and organizational policies
- Participate in quality improvement initiatives and interdisciplinary teams to enhance the overall efficiency and effectiveness of healthcare delivery
Individual Product/Commercial Customer Service Rep
Insight Global
06.2023 - 02.2024
- Communicate with patients, healthcare providers, and insurance companies to address inquiries, provide information, and resolve issues
- Assist customers in understanding their healthcare benefits, coverage, and any associated costs
- Clarify billing statements, explain insurance policies, and assist in resolving billing discrepancies
- Work with insurance providers to verify coverage and facilitate claims processing
- Stay informed about healthcare regulations, policies, and compliance standards
- Monitor and troubleshoot SharePoint-related issues, providing timely resolution
- Implement and manage SharePoint workflows to automate business processes
- Perform regular backups and implement disaster recovery plans for SharePoint environments
- Train end-users on SharePoint functionality and best practices
- Stay current with SharePoint updates and new features to recommend and implement improvements
- Collaborate with IT teams to integrate SharePoint with other enterprise systems
Claims Examiner and Benefits Specialist/Data Entry
Accolade Inc.
12.2019 - 04.2023
- Review and process insurance claims submitted by policyholders or healthcare providers
- Verify the accuracy and completeness of claim forms and supporting documentation
- Investigate claims to determine coverage, liability, and eligibility
- Analyze policy terms, conditions, and applicable laws to assess the validity of claims
- Administer and manage Microsoft SharePoint environments, ensuring optimal performance and availability
- Intake of Fax requests from providers regarding authorization
- Data entry, inputting authorizations
- Collecting information from providers
- Answering incoming calls from providers 15 to 20 calls per day
- Triage and resolve provider queries
- Create and maintain documentation for SharePoint configurations, workflows, and user guides
- Provide end-user support and training for SharePoint applications
- Monitor and evaluate the performance of SharePoint solutions and recommend improvements
Education
Data Science Program -
Bloom Institute of Technology
01.2025
High School -
WASHINGTON MATH SCIENCE TECHNOLOGY PUBLIC CHARTER HIGH SCHOOL (WMST PCHS)
01.2013
Skills
- Critical Thinking Abilities
- Interpersonal Communication
- Effective Issue Analysis
- Precision in Task Execution
- Customer Engagement Expertise
- Prioritization and Scheduling
- Versatile Skill Application
- Technical Expertise
- Effective Team Collaboration
- Empathetic Communication
- Commitment to Lifelong Learning
- Skilled in Electronic Medical Records Systems
References
References available upon request.
Timeline
Utilization Management/Billing Coordinator
GHR Center of Addiction
02.2024 - Current
Individual Product/Commercial Customer Service Rep
Insight Global
06.2023 - 02.2024
Claims Examiner and Benefits Specialist/Data Entry
Accolade Inc.
12.2019 - 04.2023
Data Science Program -
Bloom Institute of Technology
High School -
WASHINGTON MATH SCIENCE TECHNOLOGY PUBLIC CHARTER HIGH SCHOOL (WMST PCHS)
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