Shareikka Darden
Akron,OH
Summary
Experienced Credentialing Specialist adept at conducting application reviews and primary source verifications. Excellent relationship-building, problem-solving and communication skills.
Overview
16
16
years of professional experience
Work History
Provider Services Representative II
SummaCare
12.2021 - Current
- Works to ensure and improve provider satisfaction by assisting provider offices by answering questions, addressing concerns, researching/solving problems, and educating on all aspects of benefit plans and pharmacy riders
- High: collecting, analyzing data from diverse sources; making recommendations and/or conclusions based on analyses; developing financial, data processing technical reports, procedures, systems that usually affect one department
- Proofreading completed work to find and correct errors
Occasional overtime work required during peak business periods as scheduled by supervisor
Occasional travel which may require use of personal auto to attend meetings, conferences, workshops, and/or seminars
Patient Access Liaison
Summa Health
06.2019 - 12.2021
- Ability to effectively interact with populations of patients/customers with an understanding of their needs for self-respect and dignity
- Knowledge of keyboard with high accuracy and Microsoft Office products (Excel, Word, Outlook)
- Demonstrates communication, organizational and interpersonal skills
- Ability to work well within a team environment by offering and accepting honest and constructive feedback, supporting team goals, encouraging fellow team members
- Ability to be highly motivated, work independently, make decisions, and work in a fast-paced stressful environment
- Attentiveness to detail
- Organizational Competencies: Appearance, Attitude, Courtesy, Concern, Communication, Teamwork, Safety
- Functional Competencies: Customer Service Orientation, Access Operations, Quality & Compliance Management, Physician & Patient Relations, Documentation & Reporting, Employee Engagement
- Personal Attributes: Customer Focus, Adaptability and Flexibility, Ability to understand and follow directions, Communication, Professionalism, Enthusiasm, Positivity, Integrity/ethical standards, Results-oriented, Organizational skills with strong attention to detail
Provider Enrollment Specialist
Alteon Health
08.2018 - 01.2019
- Research and resolve provider related enrollment issues and coordinate with members of various departments when applicable
- Maintain the physician's files for revalidation of Medicare via PECOS
- Re-attest CAQH information for physicians as needed
- Ensure the timelines for provider enrollment to payers
- Initiate and track provider enrollment with insurance companies
- Assist providers with completion of applications and credentialing paperwork
- Follow-up with insurance companies regarding provider participation status
Provider Enrollment Specialist
Meddata Inc.
02.2016 - 08.2018
- Updating Provider information on Microsoft Excel
- Prepares and submits enrollment applications
- Follows up on the status of applications for Physicians and Payers
- Keeps detailed log of all pending and completed work
- Maintains/Updates credentialing, enrollment and contracting reports
- Manages new client start-ups, group enrollments, and special projects
- Communicates enrollment status to those involved on an as needed basis
- Other duties as assigned
- Manages state and client master applications
- Retrieves applications and/or data from central repositories for provider data. Accesses various external websites, internal matrices, and contacts organizations to verify accuracy of information provided. Identifies whether application and/or document is clean or requires further review and routes to appropriate area. Enters verified data into the Provider Data Management Systems.
- Electronically contacts providers and/or internal departments when data is incomplete. Works with internal staff members, provider office staff, academic entities and/or other health related entities to obtain additional information.
- Generates reports from system for prioritization of work queue.
- Evaluates and researches practitioners that do not meet network participation criteria or are found to have on-going sanction monitoring issues. Gathers and summarizes information for Credentialing Committee or Provider Contracting and responds to questions as needed.
- ·Researches questions for accreditation or regulatory audits.
- Supports special projects as needed.
- Performs other duties as assigned.
Claims Follow Up Rep
Mercy Health
07.2015 - 12.2015
- Ensures timely, effective and thorough management of physician practice claims to ensure full, expected reimbursement for services provided
- Proficient in Epic system
- Accesses claims from the work queue and queries claim status with the payor, utilizing all appropriate systems to effectively research the claim
- Prioritizes claims based on aging and outstanding dollar amounts, or as directed by management
- Works on assigned claims and completes all necessary activity as defined in departmental policies and procedures
- Researches and/or ensures that questions and requests for information are addressed in a timely and professional manner to ensure resolution of outstanding claims
- Completes follow-up with patients to obtain additional information, when necessary
- Performs ongoing monitoring and follow-up of claims worked to ensure maximization of collection dollars
- Executes the rebilling or reprinting of claims as necessary
Insurance Follow up Rep
PCCN INC.
07.2014 - 07.2015
- Able to work with all insurance companies on claims that haven't been paid
- Able to identify problems and trends and communicate to the appropriate manager
- Knowledge of HMOs, BC/BS, Medicare and Medicaid Claims
- Making appropriate decisions on accounts to be worked to maximize reimbursement
- Able to communicate with the client and coders to request information for claim processing
- Prepares and submits clean claims to various insurance companies either electronically or by paper
- Making appropriate decisions on accounts to be worked to maximize reimbursement
Account Receivable Specialist
McKesson Business Performance Services
07.2012 - 07.2014
- Prepares and submits clean claims to various insurance companies either electronically or by paper
- Ability to research and resolve accounts appearing on follow up reports as assigned by management
- Knowledge of HMOs, BC/BS, Medicare and Medicaid Claims
- Making appropriate decisions on accounts to be worked to maximize reimbursement
- Able to communicate with the client and coders to request information for claim processing
- Able to work with all insurance companies on claims that haven't been paid
- Able to identify problems and trends and communicate to the appropriate manager
- Developed the forms, manuals, and procedures of organization for the department
- Process patients' billing statements and reimbursement claims; post transaction data
- Manage queries and respond to them via telephone or in writing
Medical Billing Clerk
Venture Practices Services
07.2008 - 07.2012
- Distribute reports and generate bills
- Keep records of overpayment and incorporate charges shown on customer account
- Input charges for patient visit
- Maintain patients' documentation and addresses
- Process denied claims and appeals with efficiency
Bank Teller
Key Bank
07.2007 - 07.2008
- Used knowledge of company and services to obtain new accounts
- Provided quality customer service to bank customers
- Assisted customers with making deposits and bill payment
- Performed accurate and efficient cash handling
Education
STNA Certification -
Medcert
01.2012
Medical Billing Diploma -
Akron Institute
01.2008
General Studies Diploma -
Central Hower High School
01.2000
Skills
- Regulatory Compliance
- Order Processing
- Direct Sales
- Customer Service
- Call Documentation
- Promotional Support
- Intermediate Microsoft Office (Word, Excel), database reporting, OnBase (document management system), and internet navigation skills
- Knowledge of provider credentialing and/or database management procedures
- Strong data entry skills
Timeline
Provider Services Representative II
SummaCare
12.2021 - Current
Patient Access Liaison
Summa Health
06.2019 - 12.2021
Provider Enrollment Specialist
Alteon Health
08.2018 - 01.2019
Provider Enrollment Specialist
Meddata Inc.
02.2016 - 08.2018
Claims Follow Up Rep
Mercy Health
07.2015 - 12.2015
Insurance Follow up Rep
PCCN INC.
07.2014 - 07.2015
Account Receivable Specialist
McKesson Business Performance Services
07.2012 - 07.2014
Medical Billing Clerk
Venture Practices Services
07.2008 - 07.2012
Bank Teller
Key Bank
07.2007 - 07.2008
STNA Certification -
Medcert
Medical Billing Diploma -
Akron Institute
General Studies Diploma -
Central Hower High School
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