Ni'Jon Thomas
Nashville,TN
Summary
Focused administrative professional adept at planning, directing and maintaining continuous operations in various departments. Experienced in directing employees and keeping efficient production in accordance with quality standards. Applying creative and analytical approach to operations for continuous process improvement. Skilled at identifying or anticipating problems and providing solutions. Excels through mentoring, training and empowering team to excel in performance.
Overview
15
15
years of professional experience
Work History
Licensing and Credentialing Coordinator/Implementation Consultant
Integrative Health Centers (IHC)
2022.05 - Current
- Communicated effectively with third-party personnel involved in implementation efforts, coordinating activities to maximize progress.
- Collaborated with internal departments to confirm timely and accurate delivery and implementation of provider and partnership timelines.
- Oversaw all credentialing/licensing personnel through several professional service engagements.
- Ensure that medical staff members' maintain current credentials and licenses to work legally in their field or specialty
- Tracked expiration dates on documents and communicated with appropriate staff to avoid late filing.
- Maintained accurate files, records and credentialing documents in well-maintained databases using Monday, Airtable, Pipedrive, SharePoint, Microsoft Excel and etc.
- Prepared records for site visits and file audits.
- Researched and resolved barriers to successful system functionality, improving support and issue resolution.
Remote Insurance Billing Coordinator
Humana Military
2022.01 - 2022.05
- Execute billing tasks and recorded information in company databases.
- Collect data to complete detailed financial reports for stakeholders and management.
- Identify research and resolve billing variances to maintain system accuracy and currency.
- Maintain detailed and accurate records between multiple databases and programs.
- Verified accuracy of accounts payable payments, resulting in 40% reduction in payment errors and check reissues
Remote Insurance Claims Adjudicator
Solid State Operations
2021.02 - 2021.09
- Arbitrated legal disputes pertaining to government issues and program eligibility.
- Determined appropriate course of action for determining claims and settlements.
- Used investigative evidence to resolve discrepancies with unemployment claims.
- Executed claims processing, while generating increased revenue.
- Investigated high volume of insurance claims to determine validity and coverage eligibility.
- Collaborated with claims department and industry anti-fraud organizations to resolve claims.
Lead Access Specialist
Vanderbilt Medical Center/Surgical Specialties Clinic
2019.07 - 2020.09
- Provided support and supervision of surgery team; Engages regularly in formal and informal dialogue about quality.
- Coordinated and performed various functions related to research projects.
- Identified insurance payment sources and listed payers in proper sequence to establish chain of payment.
- Served as a liaison between providers, nurses, patients and health educators.
- Increased daily productivity 20% by identifying areas of need throughout clinic(s).
- Attended weekly facility meetings to discuss logistical issues and obtain updated procedural and insurance-related instructions.
Project Manager
United Healthcare/Optum
2018.12 - 2019.07
- Updated operational methods and oversaw accounting procedures for improved efficiency.
- Developed and initiated projects, managed costs and monitored performance.
- Led project teams through design, construction and launch process.
- Planned, designed and scheduled phases for large projects.
- Orchestrated projects within strict timeframes and budget constraints by solving complex problems and working closely with senior leaders.
Education
Bachelor's of Science - Health Sciences
Tennessee State University
Nashville, TN12.2015
Skills
- Project design, management and development
- Itemized Statement Preparation
- Advanced problem solving
- Employee Interviewing
- NPPES
- CAQH
- Organization and Time Management
- Revenue Growth
- Priority management
- Team Building
- Operational Efficiency
- Implementation Management
- Workflow Configuration
- Managing Multiple Projects
Timeline
Licensing and Credentialing Coordinator/Implementation Consultant
Integrative Health Centers (IHC)
2022.05 - Current
Remote Insurance Billing Coordinator
Humana Military
2022.01 - 2022.05
Remote Insurance Claims Adjudicator
Solid State Operations
2021.02 - 2021.09
Lead Access Specialist
Vanderbilt Medical Center/Surgical Specialties Clinic
2019.07 - 2020.09
Project Manager
United Healthcare/Optum
2018.12 - 2019.07
Bachelor's of Science - Health Sciences
Tennessee State University
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