Rebecca Boyd
Omaha,NE
Summary
Seasoned Credentialing Specialist with well-rounded background in healthcare administration. Previous roles have honed skills in credential verification, database management, and regulatory compliance. Strengths include exceptional organizational abilities, keen attention to detail, and thorough understanding of medical staff services operations. Notable contributions include improving efficiency in previous credentialing processes and ensuring adherence to industry standards.
Overview
22
22
years of professional experience
Work History
Patient Account Auditor
Detego Health (Position eliminated 1/25)
Omaha, NE
05.2024 - 01.2025
- Conducted detailed analysis of complex financial transactions and accounts.
- Evaluated adequacy of internal controls over financial reporting processes.
- Performed comprehensive research and data analysis to support strategic planning.
- Resolved issues related to client accounts through strong problem-solving skills.
Billing and Revenue Cycle Manager
ENT Specialists, PC (Interim Position)
Omaha, NE
09.2023 - 12.2024
- Monitored daily cash flow activity, ensuring timely filing of claims and proper reimbursement for services rendered.
- Investigated any discrepancies that arise during the billing process and resolved them promptly.
- Developed strategies to reduce denials, improve accounts receivable, and enhance revenue cycle performance.
- Implemented new policies and procedures for streamlining workflow processes within the revenue cycle department.
- Performed data analysis to identify trends in denials or rejections from payers and develop strategies for resolution.
- Reviewed patient billing information to ensure accuracy and compliance with federal and state regulations.
- Oversaw training of staff on changes in insurance regulations and coding updates impacting reimbursement rates.
Credentialing Specialist
Methodist Hospital Systems
Omaha, NE
08.2021 - 09.2023
- Maintained detailed records of provider data in the credentialing database system.
- Interacted regularly with representatives from health plans and commercial payers regarding credentialing matters.
- Researched discrepancies between submitted provider data and verified sources when necessary.
- Conducted background checks on potential providers utilizing various resources including state licensing boards, OIG and GSA Exclusion List, NPDB.
- Processed re-credentialing applications for existing providers according to contractual requirements.
- Ensured timely completion of credentialing processes by providing guidance to providers on required documentation.
- Coordinated with internal departments such as medical staff services or risk management to resolve any issues identified during the verification process.
- Validated primary source documents such as licenses, diplomas, certifications and other related credentials.
- Participated in periodic audits of credentialing files to maintain compliance with applicable regulations and policies.
Owner
Surgical Billing, LLC
Palm Springs, CA
08.2002 - 04.2021
- Developed an understanding of Medicare and Medicaid rules and regulations as they apply to medical billing procedures.
- Performed data entry into electronic health record system for all relevant patient information including diagnoses, procedures performed, medications prescribed .
- Submitted claims electronically to insurance companies in accordance with regulations.
- Monitored regulatory updates from Medicare and Medicaid programs as well as private insurers.
- Participated in meetings with physicians and other healthcare providers regarding coding compliance standards.
- Maintained detailed accounts receivable aging reports on a daily basis to ensure timely payments from patients and insurance companies.
- Verified patient information, including medical history and insurance coverage, to ensure accuracy of coding and billing.
- Conducted audits of medical records to identify missing or incorrect documentation that could affect accurate coding and billing.
- Researched denied claims to determine the cause of denial and corrected errors as needed.
- Assigned appropriate codes using ICD-10-CM for diagnosis, CPT for procedures, HCPCS for supplies and modifiers as required by payers.
- Generated reports from software systems to track claim status and denials.
- Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) in support of existing diagnoses.
- Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses.
- Resolved coding discrepancies and denials to maximize reimbursement.
- Tracked licensure expiration dates and coordinated renewal activities with providers.
- Facilitated the appointment process by providing information on privileges requested.
- Participated in Joint Commission surveys by providing requested information on physician credentials.
- Resolved complex issues with insurers regarding payment discrepancies or rejections of claims.
- Managed a team of billing specialists responsible for processing claims accurately and efficiently.
Education
Bachelor of Science - Marketing And Management
Purdue University
West Lafayette, INAssociate of Science - Nursing
Southwest Baptist University
Bolivar, MOSkills
- Financial analysis
- Revenue cycle management
- Billing compliance
- Data analysis
- Credentialing processes
- Attention to detail
- Regulatory compliance
Timeline
Patient Account Auditor
Detego Health (Position eliminated 1/25)
05.2024 - 01.2025
Billing and Revenue Cycle Manager
ENT Specialists, PC (Interim Position)
09.2023 - 12.2024
Credentialing Specialist
Methodist Hospital Systems
08.2021 - 09.2023
Owner
Surgical Billing, LLC
08.2002 - 04.2021
Bachelor of Science - Marketing And Management
Purdue University
Associate of Science - Nursing
Southwest Baptist University
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