Rochelle Martin
Euless,TX
Summary
Experienced administrative professional with 20+ years in provider credentialing services. Works productively with facilities, provider groups and individual professionals. Knowledgeable about application requirements for government and private insurance plans.
Overview
10
10
years of professional experience
Work History
Credentialing Specialist II
Aya Healthcare
01.2022 - Current
- Research, analyze, and evaluate provider applications, ensuring all relevant information has been submitted; distribute and receive the application
- Conduct research on updated state and federal regulations and policies
- Ensure credentialing applications are tracked and monitored for adherence to timelines
- Enter demographic and credentialing information into credentialing software in a timely and accurate manner
- Monitor and document credentialing efforts
- Maintain a current copy of and quickly learn/understand credentialing policies and procedures, ensuring that policies and procedures are followed, and that applications and reapplications are processed thoroughly and expediently
- Create and construct files; prepare files for review
- Keep records in licenses, credentials, and insurance contracts
- Release information to agencies and members of the public as required by law
- Ensure re-credentialing of providers according to policies and procedures.
- Enhanced credentialing processes by streamlining documentation and verification procedures.
Credentialing Specialist
Vizient (Robert Half Legal)
10.2021 - 01.2022
- Research, analyze, and evaluate provider applications, ensuring all relevant information has been submitted; distribute and receive the application
- Conduct research on updated state and federal regulations and policies
- Ensure credentialing applications are tracked and monitored for adherence to timelines
- Enter demographic and credentialing information into credentialing software in a timely and accurate manner
- Monitor and document credentialing efforts
- Maintain a current copy of and quickly learn/understand credentialing policies and procedures, ensuring that policies and procedures are followed, and that applications and reapplications are processed thoroughly and expediently
- Create and construct files; prepare files for review
- Keep records in licenses, credentials, and insurance contracts
- Release information to agencies and members of the public as required by law
- Ensure re-credentialing of providers according to policies and procedures.
Operations Administration Specialist
Charles Schwab Company (The Judge Group)
08.2021 - 11.2021
- Processing internal/external initiated service requests received via email, phone calls and other internal applications to link and/or unlink specific employee Schwab accounts that are associated with firm's Master Account(s)
- Monitoring compliance and facilitating interventions to manage risks
- Performing compliance audits and compiling reports
- Researching transaction inquiries, general product information, and data feeds
- Documenting compliance-related processes and maintaining records
- Keeping abreast of regulatory changes and developments in the regulatory environment.
Benefits Advocate-Claims Representative
UnitedHealthcare Group
08.2020 - 03.2021
- Maintained full responsibility for performing in a customer, administrative, and support role by providing quality and attentive service
- Interact regularly with a diverse customer base including responding quickly to requests and resolving problems and issues in a timely and professional manner
- Provided support by reviewing, researching, investigating, and processing claims
- Authorize payments and enter company database Analyzing and managing claims by investigating and gathering information to determine the exposure on the claim; managed claims through a well-developed action plan to an appropriate and timely resolution, ensuring claim files are properly documented and claims coding is correct
- Explained rejected claims, manually submitting claims, follow up with tool for CPT code errors
- Handling and processing claims logged invoices for payment processing
- Consistently meet established productivity, schedule adherence and quality standards.
Policy Administrator- Policy Administration
AmWins Group Benefits
10.2018 - 12.2020
- Processed member enrollments, terminations, plan changes, census changes and billing changes based on the provisions of the Account Requirements
- Research complex claims across multiple databases and prepare certificate of insurance and schedule page, including any required endorsements/ policy riders for the plan
- Assisted and provided support with special projects to include new group implementation and maintenance
- Cross-trained on most administrative functions for routine processes, maintained an accuracy level of 100% and process activities 100% in standard
- Created an insurance application package for the Underwriting department, submit files to assigned Underwriter, fulfillment packets/policy mailings and other correspondence as needed
- Research and respond to correspondence and phone calls from insured.
Quality Assurance Coordinator
The Delta Companies
03.2017 - 08.2018
- Processed and obtained all provider online applications for Allied and Permanent Placements healthcare candidates
- Reviewed applications for all requirements including licensure, certifications, work history, malpractice, and background screenings
- Completed timely and accurate screenings for all candidates using state medical board verification, DEA, ABMS, and other licensure and certification web portals
- Maintained knowledge of current healthcare guidelines, work directly with malpractice carriers to ensure all candidate files are meeting expected guidelines according to the Inter-Department guidelines, Joint Commission, and other state regulatory systems
- Maintained professional follow up and quality assurance consistent with regulatory compliance and TDC Staffing policies, procedures, and standards
- Completed weekly internal tracking system (SharePoint) to assist in the maintenance of data, pending start reports, licensure expiration reports to ensure data reflects real-time status, provided administrative support to all production recruiters, marketers, and other Risk Management and Operation team.
Eligibility Operations Advisor
Health Management Systems
08.2014 - 03.2017
- Processed new referrals for Medicaid premium assistance program
- Received cases from state referrals database system, online applications, and county Health and Human Services offices
- Prepared and maintained case files, correspondence, legal documents, and other information related to Medicaid HIPP program; coordinate actions involving accounting for payments received and/or payments disbursed
- Verified documents and coordinate information needed to process applications and Eligibility Operations assignments
- Conduct health insurance policy analysis, eligibility of aide using state MMIS systems and employer explanation of benefits
- Provided new hire training, with input for training manual documents and webinars
- Conducted daily Team meetings, complete and input contract emails, and voicemails into Workforce Management SharePoint Systems
- Process daily contract queries for Team statistics, review and perform all case Pre-Quality Assurance verification for organizational effectiveness.
Education
Certificate of Paralegal Studies -
Arlington Career Institute
Grand Prairie, TX11.2012
Skills
- EMR expertise
- Accreditation information management
- Provider Relations
- Data Management
Extensive Healthcare Background
Medical terminology, Medicare & Medicaid, Retiree, and Supplemental Plans, Insurance Eligibility & Pre-Authorization Verification, TPA Administration, Coordination of Benefits and Subrogation, Claims processing and Data Entry, Credentialing.
Subject Matter Expertise
Medical Billing/Claims and Coding, Case Management and Medical Benefits Administration, Physician Credentialing, Managed Care Contracts, HR Sourcing and Employee Relations.
Advanced Skills
MS Office applications. Workforce Management, EMR Systems, Proofreading, Customer Service, Document Processing, Transcription and Legal drafting, Quality Assurance, Time management.
Professional Highlight
20 plus years of healthcare experience. An established professional, holding a diverse past and present variation of skills and experience. Focused & detail-oriented with the ability to identify and initiate resolutions.
Timeline
Credentialing Specialist II
Aya Healthcare
01.2022 - Current
Credentialing Specialist
Vizient (Robert Half Legal)
10.2021 - 01.2022
Operations Administration Specialist
Charles Schwab Company (The Judge Group)
08.2021 - 11.2021
Benefits Advocate-Claims Representative
UnitedHealthcare Group
08.2020 - 03.2021
Policy Administrator- Policy Administration
AmWins Group Benefits
10.2018 - 12.2020
Quality Assurance Coordinator
The Delta Companies
03.2017 - 08.2018
Eligibility Operations Advisor
Health Management Systems
08.2014 - 03.2017
Certificate of Paralegal Studies -
Arlington Career Institute
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