Raheem Gibson

Columbia,SC

Summary

Executed payer contracting and audit preparation, ensuring compliance with Medicare and Medicaid regulations for organizational growth.

Demonstrated success in reducing delinquency rates and improving overall collections efficiency through strategic initiatives.

years of professional experience

MENDOTA HEALTH

MENDOTA, MN

04.2024 - 02.2026

Coordinate and execute end-to-end Provider Enrollment for multi-location medical groups, utilizing CAQH, PECOS, and NPPES (NPI) to ensure 100% provider readiness and prevent revenue disruption.
Scale credentialing operations for LPN, RN, MD, and NP providers during rapid acquisitions, ensuring all healthcare locations are revenue-ready to support growth initiatives.
Resolve complex credentialing lags and documentation errors by managing Payer Contracting timelines and maintaining proactive communication with insurance carriers to avoid claim denials.
Optimize Revenue Cycle Management (RCM) workflows by auditing insurance reimbursement applications and ensuring proper documentation for Medicare and Medicaid enrollment.
Leverage advanced tools including Medallion and Microsoft Office Suite to audit provider records and generate tracking reports for leadership on credentialing and contracting status.

BLUE CROSS BLUE SHIELD

COLUMBIA, SC

02.2023 - 04.2024

Execute initial and re-credentialing applications for a diverse provider network, maintaining zero-defect rates in Medicare and Medicaid validation protocols.
Audit and verify license validity and professional certificates to meet NCQA regulations and internal Audit Preparation standards for facility credentialing.
Coordinate the maintenance of CAQH, PECOS, and NPPES databases, ensuring data integrity for seamless Payer Contracting and provider onboarding.
Developed high-efficiency tracking systems and databases to monitor application status, significantly reducing administrative overhead during high-volume enrollment periods.

TD BANK

GREENVILLE, SC

03.2018 - 02.2023

Managed high-volume financial workflows to resolve payment discrepancies and protect organizational cash flow through aggressive Revenue Cycle management strategies.
Negotiated payment agreements and resolved customer account disputes, contributing to a significant reduction in delinquency rates.
Utilized skip tracing methodologies and investigative research to locate missing debtors and recover outstanding revenue.
Coordinated the generation of invoices and payment reminders, ensuring accurate documentation and timely processing of high-volume financial transactions.

BLYTHEWOOD HIGHSCHOOL

BLYTHEWOOD, SC