Summary
Overview
Work History
Skills
Certification
Work Preference
Timeline
Hi, I’m

Porsche Himes

FLOWER MOUND,Texas
Porsche Himes

Summary

Reliable versatile corporate professional with a solid background in healthcare, bringing a strong proven track record of driving efficiency in a variety of healthcare settings. Consistently recognized for leadership abilities in assisting and offering solutions, and overall attitude and care in doing so. Proficient in navigating the complexities of healthcare environments with meticulous attention to detail and an understanding of industry nuances. Eager to channel this expertise into the dynamic intersection of healthcare and technology, where I can contribute to the advancement of digital health solutions.

Overview

7
years of professional experience
1
Certification

Work History

IntelliCentrics -Hybrid Remote

Medical Credential Specialist
01.2023 - Current

Job overview

  • Conducted primary source verifications such as background checks and board certifications to comply with NCQA and facility specific quality standards.
  • Compared incoming data from provider facilities against quality, integrity and accuracy expectations, identified faults and affected timely remedies.
  • Performed document reproduction and approval, printing documents from electronic sources such as email attachments, drop box, platform,and sharepoint.
  • Gathered, reviewed, and compiled Approved Provider Credential summary reports each day using Excel and Adobe Pro software.
  • Currently self-managing approximately 600 providers spanning over 5 facilities across the U.S

Cardinal Health-Remote

Care Coordinator, Individualized Care
11.2022 - 12.2022

Job overview

  • Determined specific needs and provided most appropriate level of services for patient well-being.
  • Supported patient care through Asthma drug therapy program via planning and interpretation of assistance programs.
  • Conducted benefit investigations to determine patient eligibility and worked with specialty pharmacies and healthcare providers to deliver best care with least financial burden.
  • Used Salesforce to maintain records of services performed, patient insurance information, as well as prescription information.

Christus Health Headquarters-Remote

Patient Financial Representative Senior
01.2022 - 11.2022

Job overview

  • Account manager for host of clients within a region of the U.S that contain our facilities verifying payment history to evaluate conformity with insurance contracts.
  • Oversee all aspects of the account to ensure accuracy with payments, billing, adjustments, as well as documentation of events that happen within the account in regards to balance.
  • Confidential communication with clients or departments via phone, email, as well as mail if needed with the goal to resolve discrepancies on that account until it has been paid and cleared in full.
  • Resolved complex insurance and customer payment issues by providing options or escalating problems to supervisors.
  • Efficiently posted adjustments in accounting system and updated accounts to reflect new balance.
  • Applied and processed patient and insurance refunds.

Christus Health Headquarters-Hybrid Remote

Support Services Associate
01.2019 - 01.2021

Job overview

  • Starting point for all Medical correspondence shared through the entire Christus Health system for the U.S
  • High attention to detail and extreme organization in sorting and routing highly confidential medical and legal correspondence to correct patient accounts
  • Entered and tracked data in EMR system database for account building and further processing
  • Required being adaptable to meet unexpected workflow needs in a timely manner

Christus Mother Frances Hospital

EVS Tech
07.2017 - 01.2018

Job overview

  • Maintained highest standard of cleanliness and attention to detail of entire facility for patients as well as staff and guests,monitoring hospital room activity through Epic system
  • Trusted access to high security surgery areas, pharmacy,and laboratory.
  • Answered calls for the department needs
  • Excellent customer service to assist patients and guests on a regular basis with any needs or issues.
  • Cleaned, removed and properly disposed of biohazardous substances in accordance with OSHA and health regulations.
  • Assisted with special facility events by preparing rooms, installing decorations and transporting supplies.
  • Served as acting supervisor during supervisor absence

Skills

  • Computer - Microsoft Office 365, Microsoft Teams,WordPress,Salesforce,Jira,Adobe Pro,Excel
  • Healthcare-Benefit investigation,EMR Systems,Credential verification using NCQA standards,Background Investigation,Claims review and editing,Coding adjustments,Medical Record Processing
  • Financial - Cashier, Medical account balance resolution, Editing claims
  • Customer service 10years in various settings in and out of healthcare
  • Leadership - Managed team/Led training sessions when the need presented itself Sub-lead in supervisor's absence
  • Multitasking – Task managing workloads from multiple teams to meet strict deadlines and to prepare work before other are assigned

Certification

  • Business in Medicine-Udemy
  • Currently taking steps to become Salesforce Certified
  • Also looking into certifications offered by NAMSS PASS

Work Preference

Work Type

Full TimePart Time

Work Location

Remote

Important To Me

Work-life balanceCompany CultureCareer advancementHealthcare benefitsWork from home optionPersonal development programs

Timeline

Medical Credential Specialist

IntelliCentrics -Hybrid Remote
01.2023 - Current

Care Coordinator, Individualized Care

Cardinal Health-Remote
11.2022 - 12.2022

Patient Financial Representative Senior

Christus Health Headquarters-Remote
01.2022 - 11.2022

Support Services Associate

Christus Health Headquarters-Hybrid Remote
01.2019 - 01.2021

EVS Tech

Christus Mother Frances Hospital
07.2017 - 01.2018

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Porsche Himes