Rhiannon Mainville
Ellington,CT
Summary
Experienced Credentialing Specialist adept at conducting application reviews and primary source verifications. Excellent relationship-building, problem-solving and communication skills. Knowledgeable about application requirements for government and private insurance plans. Dedicated professional eager to create and implement successful strategies to improve organizational efficiency. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. Seeking to obtain and maintain a full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
12
12
years of professional experience
Work History
Credentialing Specialist
IntelyCare
03.2020 - 01.2024
- Enhanced credentialing processes by streamlining documentation and verification procedures.
- Improved turnaround time for credentialing applications by implementing an efficient online system.
- Ensured compliance with industry standards by regularly updating policies and procedures related to credentialing.
- Collaborated with healthcare providers to gather necessary information for accurate credentialing decisions.
- Reduced errors in credentialing files by conducting thorough reviews and consistently maintaining attention to detail.
- Expedited the onboarding process for new providers, ensuring timely completion of all required documentation and verifications.
- Safeguarded confidential provider information by adhering to strict data privacy regulations and company policies.
- Facilitated communication between departments, resulting in improved collaboration during the credentialing process.
- Supported quality improvement initiatives by identifying potential areas of risk within the credentialing department and recommending proactive solutions.
- Conducted audits of provider files, ensuring all necessary documents were up-to-date and compliant with regulatory requirements.
- Optimized workflow efficiency within the department through regular process evaluations and implementation of best practices.
- Provided exceptional customer service to both internal and external stakeholders, addressing inquiries promptly and professionally.
- Maintained a thorough understanding of accreditation standards, enabling accurate interpretation of guidelines for staff members when needed.
- Demonstrated excellent problem-solving skills when confronted with complex issues or discrepancies during the credentialing process.
- Contributed positively to team dynamics by fostering a collaborative and supportive work environment.
- Received and evaluated applications to look for missing and inaccurate information.
- Developed and implemented onboarding and orientation programs for new employees.
- Collected and analyzed information to monitor compliance outcomes and identify and address trends of non-compliant behavior.
Dental Receptionist
Tolland Family Dental
11.2021 - 12.2022
- Streamlined check-in and check-out processes for improved efficiency and reduced wait times.
- Resolved issues effectively, ensuring a positive customer experience.
- Processed payments accurately while adhering to company policies and procedures.
- Enhanced patient satisfaction by efficiently managing appointment scheduling and confirmations.
- Streamlined insurance claims processing for faster reimbursement and improved patient experience.
- Increased office efficiency with meticulous record-keeping of patient information, treatment plans, and payment history.
- Reduced wait times by quickly greeting patients upon arrival and assisting with the check-in process.
- Facilitated clear communication between dentists, dental assistants, and patients to ensure optimal care coordination.
- Improved billing accuracy by diligently verifying insurance coverage and updating patient financial records accordingly.
- Maintained a clean and welcoming reception area for patients, contributing to a positive dental visit experience.
- Expedited appointment scheduling through effective utilization of office management software systems.
- Provided excellent customer service by promptly addressing patient inquiries via phone, email, or in-person interactions.
- Assisted in optimizing dental practice operations by proactively identifying and resolving administrative issues or inefficiencies.
- Ensured patient privacy by adhering to all HIPAA regulations during the collection, storage, and sharing of sensitive information.
- Promoted a positive work environment by fostering strong relationships with colleagues across all roles within the practice.
- Supported dentist in maintaining accurate documentation of treatment plans for better continuity of care between visits.
- Contributed to increased new patient acquisition through referrals from satisfied existing clients as a result of exceptional customer service skills.
- Managed accounts receivable duties by timely invoicing patients for services rendered while tracking payments received or outstanding balances due accurately.
- Handled sensitive situations professionally such as discussing treatment costs or past-due account balances with patients to ensure a satisfactory resolution.
- Scheduled, rescheduled, and cancelled appointments for dental patients.
- Provided excellent customer service to create positive experiences and build patient trust.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Prepared insurance claim forms, explained benefits, and outlined pricing details for procedures and services.
- Adhered to strict HIPAA guidelines to protect patient privacy.
- Completed patient referrals to other medical specialists.
- Greeted visitors and patients to determine needs, check appointments, and direct accordingly.
- Understood dental terminology and insurance breakdowns to communicate with external stakeholders.
- Handled patient complaints quickly and professionally to restore patient confidence and prevent loss of clientele.
- Processed medical insurance claims and payments.
- Assisted with medical coding and billing tasks.
- Organized front desk area to maintain a professional and welcoming appearance for guests.
- Handled high-pressure situations calmly, maintaining professionalism at all times.
- Contributed to revenue growth by upselling rooms or promoting additional services when appropriate.
- Maintained strict guest privacy standards by securely handling sensitive information such as payment details or personal data.
- Developed strong rapport with returning guests through attentive service and personalized interactions.
Dental Receptionist
Ellington Dental
09.2018 - 09.2021
- Enhanced patient satisfaction by efficiently managing appointment scheduling and confirmations.
- Streamlined insurance claims processing for faster reimbursement and improved patient experience.
- Increased office efficiency with meticulous record-keeping of patient information, treatment plans, and payment history.
- Reduced wait times by quickly greeting patients upon arrival and assisting with the check-in process.
- Maintained a clean and welcoming reception area for patients, contributing to a positive dental visit experience.
- Assisted with medical coding and billing tasks.
- Greeted visitors and initiated triage processes for clients to streamline patient flow.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
- Managed office bookkeeping with insurance billing and patient payments.
- Conducted patient intake interviews, recording and documenting relevant information.
- Completed administrative patient intakes with case histories, insurance information and mandated forms.
- Frequently double-checked patient histories and current information while scheduling follow-ups and other appointments.
- Organized and maintained patient chart filing system to promote quick data finding for staff.
- Managed office logistics by scheduling appointments, maintaining files and collecting payments.
- Prepared and processed patient referrals and transfer requests.
- Processed medical insurance claims and payments.
- Registered and verified patient records before triage with most up-to-date information.
- Greeted and interacted with patients to provide information, answer questions and assist with appointment scheduling.
- Performed various administrative tasks by filing, copying and faxing documents.
- Scheduled patient appointments in respective doctors' calendars and followed up with reminder phone calls.
- Obtained payments from patients and scanned identification and insurance cards.
- Conducted communications and transactions with patients and visitors to foster positive experience.
- Managed patient billing processes for timely, accurate payments.
- Handled patient complaints quickly and professionally to restore patient confidence and prevent loss of clientele.
- Understood dental terminology and insurance breakdowns to communicate with external stakeholders.
Pet Groomer
Pupperdoos And Kitties Too
06.2012 - 09.2018
- Improved pet hygiene by providing thorough grooming services, including bathing, brushing, and hair trimming.
- Enhanced pet appearance through skilled fur styling and expert scissor techniques.
- Prevented injuries by safely handling pets of various sizes and temperaments during grooming sessions.
- Increased customer satisfaction with attentive care for each client''s specific needs and preferences.
- Boosted repeat business by building strong relationships with clients and their pets through friendly interactions.
- Maintained a clean, organized workspace to ensure the health and safety of both pets and staff members.
- Detected early signs of potential health issues in pets by conducting routine physical assessments during grooming appointments.
- Assisted pet owners in selecting appropriate grooming products for their pets'' needs, including shampoos, conditioners, and brushes.
- Reduced stress for anxious pets with gentle handling techniques and calming environments during grooming sessions.
- Promoted a positive image for the company by representing the business at community events and pet expos.
- Educated clients on proper at-home grooming practices to maintain their pets'' overall health between appointments.
- Collaborated with fellow groomers to share knowledge, tips, and best practices within the industry.
- Streamlined appointment scheduling processes by implementing an efficient booking system that accommodated multiple groomers simultaneously.
- Upheld strict sanitation standards by thoroughly cleaning tools, equipment, surfaces after each use.
- Achieved faster turnaround times without sacrificing quality using time management skills.
- Advised clients on post-grooming care instructions to maintain optimal results.
- Ensured client satisfaction throughout the entire grooming process from initial consultation through completion.
- Managed inventory of grooming supplies and equipment, placing orders as needed to maintain adequate stock levels.
- Greeted pet owners and went over available services, outlined costs, and determined special needs of animals under care.
- Kept animal coats clean and healthy with regular washing, grooming, and trimming.
- Spoke to customers regarding lodging, grooming, daycare services, and pricing and cross-sold additional items.
- Washed, trimmed and brushed animals to maintain good grooming standards.
- Kept cages, kennels, play yards, and grooming areas neat and clean.
- Monitored animal behavior and completed examinations to identify illnesses, injuries, or potential diseases.
- Monitored animals for behavioral problems and signs of health issues.
- Educated visitors and staff on proper animal care and handling.
Education
High School Diploma -
South Windsor High School
South Windsor, CT06.2012
Skills
- Report Generation
- Employee Onboarding
- Provider Enrollment
- Group Assistance
- Document Review
- HIPAA Compliance
- Proofreading
- Background Checks
- Insurance Procedures
- Regulatory Compliance
- Project Coordination
- Multitasking Abilities
- Attention to Detail
- Time Management
- Customer Service
- Record Keeping
- Medical Terminology
- Team Collaboration
- Critical Thinking
- Ethical Conduct
- Organizational Skills
- Interpersonal Skills
- Policy Implementation
- Analytical Skills
- Problem Solving
- Decision Making
- Procedure Compliance
- Eligibility Determinations
- In-Person and Telephone Interviewing
- Strategic Planning
Timeline
Dental Receptionist
Tolland Family Dental
11.2021 - 12.2022
Credentialing Specialist
IntelyCare
03.2020 - 01.2024
Dental Receptionist
Ellington Dental
09.2018 - 09.2021
Pet Groomer
Pupperdoos And Kitties Too
06.2012 - 09.2018
High School Diploma -
South Windsor High School
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