Ruth Wilcoxen
Jenks,OK
Summary
Efficient Credentialing Specialist known for high productivity and the ability to complete tasks swiftly. Several years of experience in the corporate ophthalmic field, credential verification, compliance management, and process improvement. Excel in communication, problem-solving, fast-learning and organization, ensuring smooth credentialing processes and effective collaboration with healthcare professionals.
Overview
7
7
years of professional experience
Work History
Credentialing Specialist
Success Vision Services
Tulsa, Oklahoma
11.2022 - Current
- Responded to verification inquiries from other healthcare organizations and insurance companies.
- Ensured strict confidentiality of provider information in accordance with HIPAA regulations.
- Managed end-to-end provider credentialing process and group contracting, ensuring compliance with industry standards for a total of nine opticals and six optometrists offices across 5 different states.
- Provided guidance and support to new providers throughout the credentialing process.
- Processed re-credentialing applications for existing providers according to contractual requirements.
- Provided support in responding to inquiries from external parties regarding credentialing information.
- Interacted regularly with representatives from health plans and commercial payers regarding credentialing matters.
- Reviewed and processed credentialing applications to ensure accuracy, completeness, and compliance with all accreditation standards.
- Coordinated with healthcare professionals to collect necessary documentation for credentialing.
- Checked applications for missing information and organized all paperwork.
- Advised management on organizing, preparing or implementing recruiting or retention programs.
- Assisted in the accreditation process by gathering and submitting required documentation.
General Manager
Success Vision Services
Tulsa, OKLAHOMA
02.2020 - 11.2022
- Delivered exceptional client experiences through hands-on leadership of associates and managers.
- Established and maintained effective communication with staff members to ensure efficient operations.
- Created a positive work environment by developing team building activities that encouraged collaboration among departments.
- Conducted employee evaluations to provide adequate feedback and recognize quality performance.
- Provided guidance and support to subordinate managers in order to foster an atmosphere of cooperation throughout the organization.
- Delegated work to staff, setting priorities and goals.
- Identified areas of improvement in current business practices and collaborated with other departments to develop action plans for implementation.
- Complied with company policies and government regulations to prevent and detect rule violations and protect organization from fines and lawsuits.
- Recruited, trained and empowered employees to achieve key performance indicators.
- Interviewed and hired qualified staff for open positions.
- Trained employees on duties, policies and procedures.
- Resolved patient complaints quickly while maintaining high quality standards of service delivery.
Optometrist Scribe
Success Vision Services
Tulsa
02.2018 - 02.2020
- Assisted with the preparation of materials for patient education and follow-up care.
- Provided assistance with administrative tasks such as filing documents, faxing paperwork and ordering supplies.
- Used EHR system to manage patient records, always maintaining patient confidentiality according to HIPAA standards.
- Performed data entry and data retrieval services for inclusion in medical records and transmission to physicians.
- Monitored patient flow throughout the day to ensure timely completion of scheduled exams and procedures.
- Evaluated charts, documents and orders and made timely corrections.
- Followed clinicians throughout shift in high-volume, busy environments.
- Monitored and updated patients' electronic health records (EHR) to reflect current diagnoses and treatments.
- Collaborated with healthcare team members to discuss and resolve documentation discrepancies.
- Assisted ophthalmologist with patient care by taking detailed medical histories, gathering pertinent data and entering information into the electronic health record.
- Maintained accurate records of patient visits including visit type, chief complaint, medications and allergies.
- Reconciled charges for billing accuracy ensuring proper coding for services rendered.
- Conducted thorough research on medical terminology to ensure accuracy in documentation.
- Reconciled clinical notes, patient forms and health information for compliance with HIPAA rules.
- Maintained confidentiality of all patient records in accordance with HIPAA regulations.
- Identified mistakes in reports and checked with doctors to obtain correct information.
- Determined correct ICD-10 and CPT codes for use in medical record.
- Provided support to physicians during examinations by preparing exam rooms, sterilizing instruments and retrieving patient charts.
- Performed basic vision tests such as visual acuity testing using a Snellen chart and color blindness testing.
- Reviewed diagnostic and procedural terminology for consistency with acceptable medical nomenclature.
- Prepared eye drops prior to surgical procedures according to doctor's orders.
- Contributed to patient care by facilitating the order of tests and prescriptions under physician guidance.
- Translated medical jargon and abbreviations into expanded forms to promote accuracy of patient and health care facility records.
Education
Bachelor of Science - Architect And City Planning
Universidade Católica De Brasília
Brasil06-2015
MBA - Management
Oral Roberts University
Tulsa, OKSkills
- Provider and Group contract and credentialing
- Eligibility and Benefits verification
- Pre authorization and referral management
- Medical and vision billing and filing
- Credentialing oversight
- Application coordination
- Credentialing documentation management
- Familiar with software and portals such as: Trizetto, Availity, Optum, RevolutionEHR, CMS, Pecos, NPPES, InstaMed, PaySpan, CAQH, RxNT, and more
- Claims, EFT & ERA enrollment
- Proficient in ophthalmic vocabulary, acronyms, CPT and ICD-10 codes
- Bilingual (English, Portuguese, Spanish)
Timeline
Credentialing Specialist
Success Vision Services
11.2022 - Current
General Manager
Success Vision Services
02.2020 - 11.2022
Optometrist Scribe
Success Vision Services
02.2018 - 02.2020
Bachelor of Science - Architect And City Planning
Universidade Católica De Brasília
MBA - Management
Oral Roberts University