- I enjoy drawing and painting which helps improve my creativity and attention to detail
- I play the drums and electric guitar
- Road Trips
- Getting involved in local advocacy groups to promote positive change in the community
- Crafting and DIY Projects
- Mindfulness Practices
- Hiking with friends
- Personal Development and Self-Improvement
Susan "Susie" Craig
Provider Data Specialist
Champaign,Illinois
Summary
Experienced with maintaining and updating provider databases to ensure accuracy and compliance. Utilizes data analysis and problem-solving skills to streamline processes and improve data integrity.
Eager to contribute to team success and further develop professional skills. Brings positive attitude and commitment to continuous learning and growth.
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Known for reliability and commitment to team success.
Overview
28
28
years of professional experience
Work History
Provider Data Specialist
VillageMD
08.2022 - Current
- Analyzed provider data for accuracy and compliance with regulatory standards.
- Managed database with provider adds, demographic changes, or terms.
- Requested W9's from provider's for new TIN# that are not in system, to ensure correct billing information.
- Collaborated with cross-functional teams to resolve discrepancies in provider information.
- Enhanced provider data accuracy by conducting thorough audits and reviews of the database.
- Managed multiple projects simultaneously, ensuring all deadlines were met while maintaining a high level of accuracy and professionalism in the work produced.
Provider Data Analyst
Health Alliance Medical Plans
04.2020 - 07.2022
- Analyzed provider data for accuracy and compliance with regulatory standards.
- Conducted audits of provider information, identifying discrepancies and recommending corrective actions.
- Managed multiple projects simultaneously while maintaining strict deadlines, showcasing exceptional organizational skills in fast-paced environments.
- Maintained compliance with industry regulations by ensuring accurate documentation and reporting of all relevant provider information.
- Enhanced data accuracy by implementing rigorous quality assurance processes and procedures.
- Produced monthly reports using Excel spreadsheet functions.
- Analyzed data to identify root causes of problems and recommend corrective actions.
Medical Claims Analyst
Health Alliance Medical Plans/Stratum Med
05.1997 - 04.2020
- Analyzed medical claims for accuracy and compliance with regulatory standards.
- Collaborated with healthcare providers to resolve discrepancies and ensure timely processing.
- Reviewed policy documents to assess coverage and determine claim eligibility.
- Streamlined documentation processes, improving turnaround time for claims resolution efforts.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Paid or denied medical claims based upon established claims processing criteria.
- Assessed medical claims for compliance with regulations and corrected discrepancies.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Processed insurance payments and maintained accurate documentation of payments.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
Electronic Medical Records Specialist
Carle Foundation Hospital/Clinics
02.2005 - 11.2005
- Consistent with accuracy while following HIPPA and CMS regulations.
- Entered Patient medical information from paper into Epic EMR. Completed assigned tasks with little to know no supervision.
- Maintained accuracy of electronic medical records through regular audits and updates.
- Collaborated with IT teams to troubleshoot technical issues related to electronic medical record systems.
- Ensured accuracy of patient data entries, leading to reduced discrepancies during insurance claims processing and billing procedures.
- Followed up with medical staff regarding missing information in patient records.
- Utilized electronic medical record systems to store, retrieve and process patient data.
- Verified accuracy of patient information in medical records.
- Used classification manuals to gain additional knowledge of disease and diagnoses processes.
Education
High School Diploma -
Parkland Community College
Champaign, IllinoisSkills
- Microsoft Office 365-Excel
- Sales Force
- EZ-CAP/EZ-NET software
- Medical records-EMR
- Data Entry
- Service excellence
- Typing speed of 45-50 wpm
- HIPAA regulations knowledge
- Experience in healthcare systems
- Data integrity assessment
- Collaborative teamwork
- Customer service
- Problem-solving
- Preparation for audits
- Time management
- Attention to detail
- Consistent reliability
- Provider relations
- Multitasking
- Excellent communication
- Organizational skills
- Effective listening
- Responsive to new challenges
- Team building
- Independent drive
- Interpersonal skills
- Goal setting
- Professionalism
- Ongoing enhancement
- Performance tuning
- Insurance confirmation
- Claims processing
Interests
Communication
Received "WAY TO BE" certificates from co-workers for helping them with projects and assisting them with customer issues.
Timeline
Provider Data Specialist
VillageMD
08.2022 - Current
Provider Data Analyst
Health Alliance Medical Plans
04.2020 - 07.2022
Electronic Medical Records Specialist
Carle Foundation Hospital/Clinics
02.2005 - 11.2005
Medical Claims Analyst
Health Alliance Medical Plans/Stratum Med
05.1997 - 04.2020
High School Diploma -
Parkland Community College
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