NIJAY REDDICK
Atlanta,GA
Summary
Dedicated Senior Credentialing and Contracting Manager with almost a decade of extensive experience in healthcare practice administration. Adept at managing the intricate processes of provider credentialing, privileging, billing, and enrollment while ensuring compliance with regulatory standards. Proven track record of streamlining credentialing operations to enhance efficiency and reduce errors. Skilled in collaborating with cross-functional teams, maintaining strong relationships with insurance networks, and facilitating the onboarding of healthcare professionals. Seeking to leverage my expertise to drive excellence in credentialing and practice administration within a dynamic healthcare organization.
Overview
10
10
years of professional experience
Work History
Practice Administrator Interim
K&H Medical PLLC
07.2023 - Current
- Supervise the daily operations, financial management, and strategic planning of a Diagnostic/Vascular radiology medical practice that includes 27 providers.
- Assembled and organized essential documentation for onboarding new providers.
- Secured the preparedness of all four surgery centers for AAASF site evaluations and acquired, as well as upheld, all office-based surgery accreditations with Medicaid for these centers.
- Led negotiations for contracts and worked in conjunction with the Chief Legal Officer to ensure equitable and accurate network agreements and fee schedules.
- Collaborated with the Chief of Compliance and providers to gather hospital affiliations and CPA (Collaborating Practice Agreement) agreements.
- Supervised team of 4 office personnel.
- Reviewed procedures and methods in collaboration with the Chief Compliance Officer, guaranteeing strict adherence to HIPAA guidelines.
- Collaborated with the Chief Legal Officer to guarantee equitable and precise network agreements and fee schedules.
- Consistently monitored NPDPD reports and remained proactive in addressing all malpractice concerns.
- Managed all Electronic Funds Transfer (EFT) and payor portals for external departments.
- Formulated and revised policies and protocols, ensuring ongoing compliance with HIPAA regulations, benefits administration, and general liability standards.
- Collaborated with the billing and collections department to resolve issues related to accounting, billing, and service delivery, with a focus on improving overall satisfaction.
Senior Credentialing and Contracting Manager
K&H Medical PLLC
12.2022 - Current
- Expert knowledge and comprehensive familiarity with the network participation guidelines, application procedures, contract terms, and credentialing prerequisites for over 40 networks in the states of New York, New Jersey, and Pennsylvania.
- Completed and monitored all initial provider enrollment and credentialing applications on behalf of a team of nine medical doctors, six physician assistants, and twelve nurse practitioners to over 40 insurance companies operating in New York, New Jersey, and Pennsylvania.
- Successfully carried out the initial enrollment for group and facility contracts, as well as the re-credentialing process.
- Acquired state licensure, federal DEA certification, CVs, physicals and infectious control documentation, board certifications, ACLS/BLS certifications, undergraduate and medical school records, internship and residency details, fellowship information, and hospital affiliations for all providers. Possess comprehensive expertise in all aspects of Medicaid and Medicare, whether pertaining to hospitals, nursing homes, or group practices.
- Conducted verification of credentials, background checks, and board certifications.
- Thoroughly ensuring the completion and precision of all providers' CAQH accounts.
- Monthly compilation of network rosters to ensure the accuracy of practice addresses with health plans and agencies.
- Collected and maintained the precise and confidential personal data of providers, ensuring accuracy and privacy.
- Managed the tracking and renewal of provider credentials and licenses to ensure uninterrupted healthcare services.
Collections Coordinator
Mobile Vascular Physicians
02.2022 - 12.2022
- Expertise in all insurances, mainly Medicaid and Medicare, their rules, and filing guidelines.
- Reviewed denials or partially paid claims, corrected claims, and worked with the involved parties to resolve the discrepancy.
- Managed assigned accounts to ensure outstanding/pending claims are paid within the timely filing guidelines.
- Reviewed patient bills for accuracy and completeness; Obtained all missing information to properly submit claims.
- Identify insurance company or proper party to be billed; identify and bill secondary or tertiary insurances.
- Utilized a combination of electronic health record (EHR), electronic medical records (EMR), and paper patient records to perform billing duties.
- Processed online and paper appeal submissions and refund requests.
- Corrected, completed and processed claims for multiple payer codes.
- Logged charges and payments within Cybermed, Advanced Data Systems, and Change Healthcare.
- Processed billing calls and answered questions from patients and third-party carriers.
- Established relationships with patients and their families to encourage payment of delinquent accounts.
- Consult with supervisor, team members, and appropriate resources to solve billing and collection questions or issues.
Accounts Receivable Specialist
Rego Park Health Care
02.2019 - 02.2022
- Compiled bi-weekly Medicaid cycle billing for 385-bed facility, as well as any rebilling.
- Reviewed accounts on monthly basis to assess aging and pursue collection of funds.
- Posted all Social security, Pension, and outstanding NAMI deposits (check deposits, as well as direct deposits)
- Prepared billing statements and invoices for residents outstanding NAMI and recorded transaction dates and fees to support accuracy.
- Reconciled accounts receivable ledger to verify payments and resolve any variances.
- Tracked contracts, proposals and waivers to keep billing accurate and current.
- Worked with Medicaid Coordinator to properly apply residents remittances.
- Managed care costs and billing and resolved financial discrepancies effectively through organizational management of account information using Optimum Financial and PointClick software.
Medicaid Billing Specialist
Citadel Rehab and Nursing Center
08.2018 - 02.2019
- Complied weekly Medicaid billing and re-billing.
- Submitted yearly Rep Payees to Social Security
- NAMI collections
- Assisted the Medicaid Coordinator with Medicaid applications
- Interviewed residents and their families and explained scope of different available benefits.
- Scheduled appointments with residents family to gather information and explain benefits processes.
- Inputted all gathered information and researched data on applicants into computer system using Optimum Financials.
Medicaid Liason
Revenue Enhancement Services
03.2017 - 08.2018
- Responsible for transporting confidential documentation from HRA as needed.
- Handled Medicaid recertification and additional billing.
- Distributed important paperwork to members of the team and flagged issues to upper management as needed.
- Ensured compliance of all areas of the facility’s policies and procedures.
- Managed office telecommunications and troubleshoot all billing issues as they arose.
- Prepared, processed, and maintained forms, reports, logs, records, and all facility activity.
- Wrote incident reports and misconducts for infractions within the facility when needed.
- Resolved conflicts in a tactful professional manner by communicating effectively to diffuse situations.
- Networked with local organizations, leaders and consumers, resulting in establishment of new and lasting partnerships and relationships.
Office Assistant
1313 Realty Co
02.2014 - 03.2017
- Delivered clerical support by handling range of routine and special requirements.
- Produced high-quality documents, spreadsheets and presentations for internal and customer-facing needs.
- Verified accuracy of business records by consistently updating customer information.
- Oversaw automated tracking and documentation of data, client correspondence and office operations.
- Interacted with customers by phone, email or in-person to provide information.
- Processed invoices and expenses using QuickBooks to facilitate on-time payment.
- Streamlined processing procedures for various financial and employee documents to improve traceability.
Education
Bachelor of Arts - Healthcare Administration
Queens College of The City University of New York
Flushing, NY05.2025
Skills
- Proficiency in CAQH
- AAASF Accreditation
- Office Based Surgery Accreditation
- Expert in eMEDNY, NGS, DrChrono, , Optimum Financials, PointClick, Visual, MEDS system, Microsoft Word, and Microsoft Excel
- Revenue Cycle Management
- Bill Payment and Recordkeeping
- Time Management
- Attention to Detail
- New Hire Training
- Managing Medical Practices
- Credential Verification
Timeline
Practice Administrator Interim
K&H Medical PLLC
07.2023 - Current
Senior Credentialing and Contracting Manager
K&H Medical PLLC
12.2022 - Current
Collections Coordinator
Mobile Vascular Physicians
02.2022 - 12.2022
Accounts Receivable Specialist
Rego Park Health Care
02.2019 - 02.2022
Medicaid Billing Specialist
Citadel Rehab and Nursing Center
08.2018 - 02.2019
Medicaid Liason
Revenue Enhancement Services
03.2017 - 08.2018
Office Assistant
1313 Realty Co
02.2014 - 03.2017
Bachelor of Arts - Healthcare Administration
Queens College of The City University of New York
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