Renee F. Monts
Philadelphia,PA
Summary
Professional with strong background in customer interactions and service solutions. Highly skilled in conflict resolution, communication, and problem-solving, ensuring customer satisfaction and loyalty. Effective team collaborator, adaptable to changing needs, and consistently focused on achieving results through efficient and empathetic service. Known for reliability and proactive approach to meeting customer and organizational goals.
Overview
19
19
years of professional experience
Work History
Credentialing Specialist
Temple University Hospital, Inc
Philadelphia, PA
03.2019 - Current
- Collaborates with Physician's to gather necessary information for accurate credentialing decisions.
- Manages multiple priorities effectively, resulting in the on-time completion of credentialing tasks for numerous providers simultaneously.
- Conduct's audits of provider files, ensuring all necessary documents were up-to-date and compliant with regulatory requirements.
- Conduct's primary source verifications such as background checks and board certifications.
- Prepares records for site visits and file audits.
- Facilitates communication between departments, resulting in improved collaboration during the credentialing process.
Senior Provider Database Coordinator
Health Partners Plans
Philadelphia, PA
10.2014 - 02.2018
- Increased productivity; took initiative to learn SAS Enterprise Guide to improve department’s ability to perform query and data mining for various reports for Network Management
- Functioned as SAS subject matter expert and the only member of team with ability to run reports
- Mentored and trained 13 new Provider Database Coordinators; created training documents, system handbooks and provided hands on chair side instruction to increase productivity and retention
- Demonstrated analytical and problem solving ability by designing and implementing streamlined work processes to address barriers to receiving and validating accurate provider information
- Pioneered process for creating and utilizing 5 digit dummy numbers when registering new Urgent Care Centers which increased efficiency
- Introduced audit spreadsheet and checks/ balance system to validate and process provider updates, W9’s and non-par letter distribution
- Eliminated duplicate work and aided claims department in submitting payment quicker
- Handled EDI claim request for non-participating and hospital based providers
Provider Database Coordinator
Health Partners Plans
Philadelphia, PA
10.2009 - 10.2014
- Hired to support newly created three member provider data department
- Gained recognition for proactively taking on senior level coordinator responsibilities including learning new systems, training new employees and building collaborative cross-functional relationships
- Accurately entered demographic data of new providers into MHS; assigned fee schedules, pricing and contract information
- Completed Macess Service Forms within required turnaround time demonstrating prioritization skills and ability to work independently with minimal supervision
- Reviewed and updated provider sanctions according to OIG and EPPLS websites
Credentialing Services (Temporary Assignment)
Health Partners (via Hobart West Solutions)
Philadelphia, PA
05.2008 - 10.2009
- Utilized knowledge of MHS, Cactus and Macess to completed, reviewed and updated all credentialing and re-credentialing applications
- Maintained compliance with all Federal, State regulations, NCQA standards, and managed care criterion related to the credentialing and re-credentialing of practitioners, organizational providers and LTSS providers
- Confirmed physician’s licensing using the State License website; updated physician’s medical license in Cactus and MHS based on mismatch error report
- Updated over 100 physician’s Medicaid and NPI numbers
Reservation Agent
Sky Resort Management
Orlando, FL
11.2007 - 03.2008
- Handled all telephone inquiries with prompt courtesy, while applying the resorts selling strategy and selling technique, in order to achieve budgeted goals and maximize revenue
- Responded to telephone, email and fax inquiries from customers and staff in a professional and courteous manner
- Provided high level of customer service to each person by engaging customer and using active listening and effective interpersonal skills.
- Answered incoming phone calls and developed friendly rapport with callers while answering questions, making recommendations, and leading conversations to bookings.
- Worked closely with front desk to achieve full occupancy of property.
Customer Service Representative
Precedent Management LLC
Kissimmee, FL
02.2006 - 10.2007
- Delivered outstanding service; answered over 75 daily inbound and outbound calls within online pharmacy call center
- Utilized multiple screens of information to address customer needs
- Validated and entered customer payment into system database with 100% accuracy
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Assisted customers in navigating company website and placing online orders, improving overall user experience.
Education
School Diploma -
Murrell Dobbins Vocational High School
Philadelphia, PA06.1995
Skills
- MHS
- Macess
- SAS Enterprise Guide-51
- IntelliCred
- IntelliContract
- CCMS
- Microsoft Office Suite
- Cactus
- Echo
Timeline
Credentialing Specialist
Temple University Hospital, Inc
03.2019 - Current
Senior Provider Database Coordinator
Health Partners Plans
10.2014 - 02.2018
Provider Database Coordinator
Health Partners Plans
10.2009 - 10.2014
Credentialing Services (Temporary Assignment)
Health Partners (via Hobart West Solutions)
05.2008 - 10.2009
Reservation Agent
Sky Resort Management
11.2007 - 03.2008
Customer Service Representative
Precedent Management LLC
02.2006 - 10.2007
School Diploma -
Murrell Dobbins Vocational High School