Roxann Gray
Granville,OH
Summary
Dynamic and results-oriented healthcare professional with over 10 years of experience as an expert credentialer, medical, and infusion biller. Leverages a robust clinical background and extensive expertise in healthcare administration to ensure compliance, streamline processes, and optimize patient care delivery. Proven ability to excel in fast-paced environments, drive operational efficiency, and deliver exceptional results. Passionate about contributing to healthcare excellence through continuous improvement initiatives and collaborative teamwork.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Operating Room Assistant
Mount Carmel New Albany
03.2024 - Current
- Assisted surgical team in various procedures, including prepping operating rooms, sterilizing instruments, and providing support during surgeries
- Ensured adherence to sterile techniques and maintained a safe surgical environment for patients and staff
- Collaborated effectively with surgeons, nurses, and other healthcare professionals to optimize patient care.
Credentialing Manager
Gifted Healthcare
01.2023 - 02.2024
- Leads, coordinates, and monitors the review and analysis of clinician applications accompanying documents, ensuring applicant eligibility
- Assessed business risks through assessments and mitigation strategies and decision-making with detailed reports for executive team
- Oversaw employee recruitment, training, and onboarding processes
- Audited employee performance for quality control using real-time BI data and reports.
Credentialing Specialist
Gifted Healthcare
01.2022 - 01.2023
- Prepares credential files for completion and presentation to vendor systems or Joint Commission, executing file completion within time frame specified
- Conducts thorough background investigation and evaluation, validates discrepancies, and ensures appropriate follow up
- Brought in highly qualified applicants, targeted recruitment strategies on key candidate pools.
Sr. AR Infusion Billing Specialist
OhioHealth
09.2018 - 01.2023
- Processed medical and home infusion claims, adjustments, and statements
- Balanced and reconciled discrepancies in financial records
- Identified, studied, and recommended solutions to clinical service problems while obtaining prior authorization for infusion services as needed on 50% of claims
- Conducted Monthly LEAN Six Sigma projects for PBM infusion and home health operations, with monthly improvements of 90% of department KPI’s.
Hospice and Private Duty Aide
National Church Residences
05.2020 - 12.2021
- Administered treatments, managed catheters, and cleaned patients under the direction of clinical staff
- Delivered specimens to laboratory and returned to unit with reports
- Resolved patient issues by quickly responding to calls and emergencies
- Offered reminders to patients about medications, supplements, and treatments.
Credentialing & Contracting Coordinator
ABCS RCM
04.2017 - 11.2019
- Professionally dealt with team members and clients to enhance relationships
- Completed revalidation requests and re-credentialing applications
- Processed DEA & Clinical licenses collected fees and filed paperwork
- Proactively warned holders of identified infractions and penalties to prevent further violations; scheduled meetings and appointments with clients to discuss progress.
Physician Credentialing
UnitedHealth Group
04.2015 - 05.2017
- Ensured compliance with regulatory bodies (Joint Commission, NCQA, CMS, Federal/State) by managing the credentialing process
- Submitted and prepared recommendations regarding Credentialing and Re-Credentialing of Providers and Health Delivery Organizations, to the Credentialing Committee
- Maintained internal provider grid to promote accurate information and available logins
- Optimized efficiency by utilizing and maintaining the credentialing database, performing queries, and generating reports.
Education
High School Diploma -
Gahanna Lincoln High School
Gahanna, OHSurgical Technologist -
Auburn University
Auburn, AL04.2024
CNA Diploma -
Premier Choice Health Services
Columbus, OH01.2013
Skills
- Calm Under Pressure
- Team Leadership
- Interpersonal relationship building
- Provider enrollment
- Documentation Review
- ICD-10 Proficiency
- HIPAA Compliance
- Payment posting
- Claim submission
- Insurance Verification
Certification
- AHA BLS, 01/26
- Apex NIH Stroke Scale, 01/25
Timeline
Operating Room Assistant
Mount Carmel New Albany
03.2024 - Current
Credentialing Manager
Gifted Healthcare
01.2023 - 02.2024
Credentialing Specialist
Gifted Healthcare
01.2022 - 01.2023
Hospice and Private Duty Aide
National Church Residences
05.2020 - 12.2021
Sr. AR Infusion Billing Specialist
OhioHealth
09.2018 - 01.2023
Credentialing & Contracting Coordinator
ABCS RCM
04.2017 - 11.2019
Physician Credentialing
UnitedHealth Group
04.2015 - 05.2017
High School Diploma -
Gahanna Lincoln High School
Surgical Technologist -
Auburn University
CNA Diploma -
Premier Choice Health Services