NICOLE SABBAT
Jacksonville
Summary
Senior Provider Data & Credentialing Specialist with extensive experience at United Health Group, specializing in provider verification and application auditing. Proven ability to enhance data integrity and improve compliance in credentialing processes. Strong attention to detail and problem-solving skills contribute to increased efficiency and team collaboration.
Overview
20
20
years of professional experience
Work History
Senior Provider Data & Credentialing Specialist
Health Group
Jacksonville
01.2020 - 01.2025
- Responsible for verifying current and accurate data has been submitted.
- Audits applications for accuracy and completeness.
- Reaching out to providers or credentialing agencies to obtain missing details or documents.
- Responsible for verifying provider information via online credentialing databases and systems (NATIONAL STUDENT CLEARINGHOUSE, CAQH, Verisys, ABMS, NPDB, NPPES)
- Responsible for PrimeSource Verification of State license, DEA, and Board certification.
- Responsible for Completing provider initial credentialing applications.
- Responsible for submitting completed credentialing applications with supporting documentation or sending for Medical Review as appropriate.
Senior Provider Data Specialist
United Health Group
Lithonia
01.2017 - 01.2019
- Oversaw database maintenance for Providers, conducting rigorous quality checks to ensure documentation accuracy and uphold data integrity, resulting in more reliable reporting and compliance with data standards.
- Conducted audits, providing feedback as needed to reduce errors and improve processes and performance.
- Submitted appropriate reports to the senior management team reflecting work completed and areas of opportunity.
- Reported and tracked provider calls, working to resolve any issues/concerns to retain loyal business and increase client satisfaction.
- Collaborated with the team to manage projects from inception to completion.
Collector
Children’s Healthcare of Atl (Aerotek Staffing)
Atlanta
01.2016 - 01.2017
- Conducted account management, working hard to reconcile and close open accounts.
- Proficiently navigated through web-based portals to manage client accounts, update demographics, and process payments.
- Participated in meetings for professional development and updates on company processes.
- Effective communication with staff/management/Credentialing and Utilization Management department to obtain retro SCAs and authorizations for tests/procedures.
- Provided on-the-job training to new hires and served as Subject Matter Expert to current staff.
- Worked alongside staff, setting the example in customer service, professionalism, and adherence to organizational policies.
Team Lead Managed Care Biller
National Vision
Lawrenceville
01.2014 - 01.2016
- Communicated with a diverse group of people to assist in scheduling transports, billing matters, and any questions about the service.
- Evaluated provider charges including dates of service, procedures, level of care, locations, and patient demographics.
- Prepared all claims documentation including referrals, treatment plans, or required correspondence to reduce denials.
- Submitted claims using 837 electronic, CMS-1500, and the online web portal.
- Processed 20-25 claims per hour and managed all rejections.
- Performed patient check-ins and scheduled follow-up appointments.
- Collected Copays, billed the patient's insurance companies, and managed the telephone switchboard.
- Ensured accurate management reporting of activities and procedures done daily.
- Maintained and organized files, faxed, photocopied, and prepared documents for billing, and put CPT and ICD-9 in the computer manually.
- Met and exceeded individual goals set for me by my Manager to meet daily quotas for a number of accounts claims processed per hour and gladly took on additional assignments and projects as needed.
Provider Relations Rep | Case Manager
PRXG Global Inc.
Atlanta
01.2012 - 01.2013
- Reviewed audited claims cases for Medicare and Medicaid.
- Utilized the Case Management Tracker for assigned areas while working the Provider Issues Log.
- Participated in meetings for professional development and updates on organizational processes.
- Submitted recommendations for process improvement to enhance overall efficiencies.
- Managed cases from inception through to completion.
Patient Account Rep I, II, And III
Emory Healthcare-The Emory Clinic
Decatur
01.2005 - 01.2012
- Obtained complete and accurate demographic and financial information from a variety of sources, including patient interviews, physician offices, and in-house departments.
- Verified patients' insurance eligibility and collected patient responsibility payments, maintained patient charts for Business Office and Medical Records.
- Efficiently expedited patient records between the Business Office, Medical Records, and Registration in a 24-hour window of completion.
- Established appropriate methods of reception for the Emergency Room and Outpatient Services.
- Promptly and compassionately greeted and assisted all patients on time, performed as stand-in switchboard operator as needed.
- Improved admission processes and through innovative observation, implemented a new intake procedure that saved hospital staff time and liability in document security.
- Provided demographic information to insurance companies and called physicians' offices if clinical information was needed for pre-certification and verified the information obtained.
- Demonstrated ability to be dynamic and learn new processes and procedures quickly and efficiently.
Education
High School Diploma -
CHELSEA HIGH SCHOL
Chelsea, MA06-1986
Skills
- MS Office proficiency
- Provider verification and relations
- Application auditing
- Attention to detail
- Effective communication
- Team collaboration and management
- Time management
- Problem solving
- Document review and reporting
- License and credential verifications
- Insurance procedures and claims processing
- Medical records management
- Conflict resolution strategies
- Cross-functional collaboration
- Efficiency improvement techniques
- Medical terminology expertise
- Customer service excellence
Websites
Professional Summary - Branding Statement
Motivated, results-oriented, and dependable professional with extensive expertise in a fast-paced environment utilizing excellent Customer Relations and Service Satisfaction. Proficient in job execution and proven track record of success in compliance, and account management. Strategic and creative thinker with a solid background in delivering decisive, action-driven leadership. Demonstrates expert insight and proficiency in teaching, coordinating, monitoring, evaluating, and communicating with clients. History of success in managing and coordinating operations and administrative support, using initiative, resourcefulness, and good judgment. Performance-Driven Team Player with excellent interpersonal skills and attention to detail, optimally utilizing all channels of communication to assist operations.
Timeline
Senior Provider Data & Credentialing Specialist
Health Group
01.2020 - 01.2025
Senior Provider Data Specialist
United Health Group
01.2017 - 01.2019
Collector
Children’s Healthcare of Atl (Aerotek Staffing)
01.2016 - 01.2017
Team Lead Managed Care Biller
National Vision
01.2014 - 01.2016
Provider Relations Rep | Case Manager
PRXG Global Inc.
01.2012 - 01.2013
Patient Account Rep I, II, And III
Emory Healthcare-The Emory Clinic
01.2005 - 01.2012
High School Diploma -
CHELSEA HIGH SCHOL