PARIOUS HAYNES
Summary
Credentialing Specialist with extensive experience at Delta Dental, specializing in medical billing, coding, and insurance verification. Demonstrated success in enhancing provider relationships and optimizing credentialing processes for compliance and accuracy. Skilled in data management and maintaining HIPAA standards, providing exceptional service in high-pressure environments.
Overview
20
20
years of professional experience
Work History
Credentialing Specialist
Delta Dental
07.2024 - Current
- Screens provider credentialing and re-credentialing packets for missing information, request missing information from provider, resolves discrepancies between information supplied and findings of other sources.
- Creates and updates provider information in the system to ensure that credentials are completed within a timely manner and at a high level of accuracy.
Hospital Credentialing Specialist
Tanner Healthcare
05.2021 - 05.2024
- Maintain a positive relationship with the hospital medical staff and ensure providers receive their privileges in a timely manner.
- Regularly communicate with hospital medical staff to obtain information, provide information and ascertain any credentialing status or changes for the providers.
- Maintain records of applications, documents, and verification letters Evaluate information on applications to verify completeness and accuracy.
- Ensure malpractice insurance coverage is continually active for each provider.
Customer Service Vendor Specialist
Piedmont Healthcare
11.2022 - 05.2023
- Respond to incoming requests from customers, ensure issues are addressed promptly, and follow through to resolution in an efficient, timely, and accurate manner.
- Works collaboratively with supply chain and accounts payable staff in addressing customer concerns and questions.
- Evaluate vendor build and update requests for accuracy ensure Tax ID Number validation with IRS record and existing vendor base to minimize risk of fraud and payment error and duplication.
Billing Specialist
Guardian Pharmacy
06.2021 - 11.2022
- Responsible for adjudicating medical claims from providers billing Medicare, Medicaid, Tricare, and commercial insurance Review pricing methodology for multiple plans Ensured compliance with all applicable Federal, State and/or County laws and regulations related to our documented guidelines and processes.
- Maintains compliance with all company policies and procedures.
- Processes claims by entering patient, payment, and provider information timely and accurately from AUB or CMS claim form Identify and correct all duplicate or corrected claims received.
- Responsible for accurate data entry of resident insurance information Review of resident face sheets and make corrections if needed Verify and change any financial pay statuses.
- Provides customer service and problem resolution to assigned facilities.
Remote Customer Service Representative
Activus
05.2021 - 05.2022
- Review client accounts and accurately record information via inbound and outbound phone calls Identify and assess clients' needs to achieve satisfaction.
- Provide accurate, valid, and complete information by using the right methods and tools.
- Obtain and keep records of client interactions, process client accounts, and file documents dispatch providers, verify demographic information, and make outbound phone calls to insurance companies.
- Accept payments and utilize Microsoft Office and STP software.
Remote Customer Service Representative
SITEL
10.2013 - 05.2021
- I answered inbound phone calls and online chats and reviewed and resolved escalated trouble tickets.
- Performed troubleshooting, asked probing questions, promoted services, and provided technical support.
- Oversaw billing, answered account questions, documented interactions, and completed end of day reports.
Claims Processing Associate / Customer Service
Delta Dental
03.2018 - 01.2019
- Interfaced with customers via inbound and outbound phone calls.
- Approved and denied claims, verified insurance coverage, and submitted paperwork for denials.
- Entered medical codes for dental services provided, entered data into the computer, and maintained HIPAA compliance.
Customer Service Representative
Alorica
04.2005 - 12.2013
- Enrolled clients into Medicaid and Medicare plans via inbound and outbound phone calls.
- Processed and posted payments, performed troubleshooting, and explained billing inquiries.
- Verified insurance coverage and acted with discretion when handling confidential information.
Education
Associate of Applied Science -
Ultimate Medical Academy
Tampa, FLSkills
- Medical billing and coding
- Insurance verification and claims
- Revenue cycle management
- Electronic health records
- Accounts receivable and collections
- Co-pay, deductibles, and co-insurance
- Call center operations
- Government programs (Medicare & Medicaid)
- Managed care procedures (HMO, PPO, POS)
- Anatomy and physiology knowledge
- HIPAA compliance expertise
- Data management and maintenance
- Document review processes
- Employee onboarding procedures
Timeline
Credentialing Specialist
Delta Dental
07.2024 - Current
Customer Service Vendor Specialist
Piedmont Healthcare
11.2022 - 05.2023
Billing Specialist
Guardian Pharmacy
06.2021 - 11.2022
Hospital Credentialing Specialist
Tanner Healthcare
05.2021 - 05.2024
Remote Customer Service Representative
Activus
05.2021 - 05.2022
Claims Processing Associate / Customer Service
Delta Dental
03.2018 - 01.2019
Remote Customer Service Representative
SITEL
10.2013 - 05.2021
Customer Service Representative
Alorica
04.2005 - 12.2013
Associate of Applied Science -
Ultimate Medical Academy
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