Credentialing Specialist
HCA Healthcare Inc.
10 2022 - Current
Hi, I’m
Tiffany Johnson
Olive Branch,MS
Summary
To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills. As a detail-oriented team player with strong organizational abilities, In addition to handling multiple projects simultaneously with a high degree of accuracy.
Work History
HCA Healthcare Inc.
Credentialing Specialist
10 2022 - Current
Job overview
- Received and evaluated healthcare provider initial and re-credentialing applications to look for missing and inaccurate information.
- Safeguarded confidential provider information by adhering to strict data privacy regulations and company policies.
- Expedited onboarding process for new providers, ensuring timely completion of all required documentation and verifications according to established policies, rules and procedure.
- Conducted primary source verifications such as background checks and board certifications.
- Conducted audits of provider files, ensuring all necessary documents were up-to-date and compliant with regulatory requirements, while monitoring expirables report and client outstanding items.
- Demonstrated excellent problem-solving skills when confronted with complex issues or discrepancies during credentialing process.
Tend Dental
Welcome Desk Attendant
10 2021 - 10 2022
Job overview
- Greeted visitors and patients to determine needs, check appointments, and direct accordingly.
- Understood dental terminology and insurance breakdowns to communicate with external stakeholders.
- Prepared insurance claim forms, explained benefits, and outlined pricing details for procedures and services.
- Scheduled, rescheduled, and cancelled appointments for dental patients.
- Adhered to strict HIPAA guidelines to protect patient privacy.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Communicated with insurance companies to dispute unpaid claims and verify patient coverages.
- Contributed to increased new patient acquisition through referrals from satisfied existing clients as aresult of exceptional customer service skills.
- Expedited appointment scheduling through effective utilization of office management software systems.
East Marietta Family Dentistry
Insurance Coordinator
06 2019 - 10 2021
Job overview
- Obtained data such as patient, insurance ID, insurance provider and medical/dental codes to properly file insurance claims.
- Monitored changes in dental insurance policies and communicated updates to staff, enabling staff to stay informed about latest industry standards.
- Ensured timely payment collection from both patients and insurance companies by diligently tracking outstanding balances.
- Negotiated pre-authorizations for necessary dental procedures, securing coverage for vital treatments otherwise not covered.
- Reduced billing errors by consistently verifying insurance eligibility prior to service delivery.
- Assisted patients in understanding their dental insurance benefits, coverage limits, and out-of-pocket expenses.
Roswell Smiles
Benefits Coordinator
10 2016 - 06 2019
Job overview
- Explained benefits to plan participants in easy to understand terms in order to educate each on available options.
- Reduced billing errors by diligently reviewing claims and identifying discrepancies before submission.
- Provided exceptional customer service to patients, addressing their concerns and answering questions regarding insurance benefits.
- Served as liaison between patients, providers, and insurance companies to resolve claim issues and ensure timely reimbursement.
- Developed strong relationships with both patients and providers by consistently demonstrating professionalism and empathy.
- Supported administrative tasks such as filing paperwork, maintaining supply inventory levels, or assisting with front desk duties as needed.
- Assisted patients in understanding their insurance coverage, explaining plan details and coordinating necessary authorizations.
- Increased revenue for practice by diligently working towards obtaining maximum reimbursements from insurers.
Education
Hillsborough Community CollegeTampa, FL
Physical Therapy from Sports Medicine
Gwinnett CollegeLilburn, GA
Massage Therapy from Neuromuscular Therapy
Skills
- Candidate Sourcing
- File and records management
- Time Management
- Verbal and Written Skills
- Multi-Task
- Critical Thinking
- Medical and Dental Terminology
- Ability to work Independently
- Remote Office Availability
- Microsoft Word
- Attention to Detail
- Organizational Skills
Timeline
Welcome Desk Attendant
Tend Dental
10 2021 - 10 2022
Insurance Coordinator
East Marietta Family Dentistry
06 2019 - 10 2021
Benefits Coordinator
Roswell Smiles
10 2016 - 06 2019
Hillsborough Community College
Physical Therapy from Sports Medicine
Gwinnett College
Massage Therapy from Neuromuscular Therapy
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