TRACEY TAMBLYN
Billings,MT
Summary
With a proven track record at Aspirus, Inc., I excel in provider enrollment and documentation management, showcasing strong data entry skills and exceptional customer service expertise. My ability to optimize workflows and foster provider relations has significantly enhanced operational efficiency, demonstrating my commitment to excellence and teamwork.
Overview
30
30
years of professional experience
Work History
Provider Insurance Enrollment Specialist
Aspirus, Inc.
Wausau, USA
05.2021 - 11.2024
- Company Overview: Aspirus, Inc
- Is a healthcare organization providing a range of services including hospital care and outpatient services
- Website: aspirus.org
- Enroll all provider types to Government insurance payors: CMS Medicare, Wisconsin Medicaid, Michigan Medicaid
- Add providers to specific Hospital/Clinics locations
- Ensure all information related to the enrollments are updated in a timely and accurate manner
- Maintain provider state licenses, DEA certificates, malpractice insurance and any other expirable documents
- Populate, maintain, update credentialing database to ensure accountability for the integrity of the information entered
- Respond to requests/inquiries from health plans, as well as other departments by email
- Access external databases to obtain required documents necessary to complete credentialing applications
- Detailed knowledge of insurance enrollment process for contracted and governmental payors
- Update and re-attest information with CAQH (Council for Affordable Healthcare) quarterly for each provider enrolled
- Aspirus, Inc
- Is a healthcare organization providing a range of services including hospital care and outpatient services
- Website: aspirus.org
Provider Data Specialist
SCL Health - Rocky Mountain Health Network
Billings, USA
01.2018 - 09.2021
- Company Overview: SCL Health is a healthcare organization that provides a range of services including hospital care and outpatient services
- Website: rmhn.org
- Receives information regarding new practitioners from Clinics, Onboarding, Medical Staff office, Office Managers and ensure applications are appropriately signed, complete and accurate
- Respond to all requests/inquiries from health plans, as well as other departments
- Enters and saves application data into credentialing software database
- Maintain provider state licenses, DEA certificates, malpractice insurance and any other expirable documents
- Prepares approval letters, credentialing lists for committee review, panels, and Provider Rosters for submission to commercial payers
- Submit BCBS onboarding form to enroll providers via BCBS portal
- Maintain necessary logs, lists, records, and current documentation required for physician/provider credentialing and re-credentialing
- Communicates with various payers, clinics, billing offices, practitioners, and leadership regarding the status of enrollments on an ongoing basis
- Ability to prioritize tasks and projects assigned to meet deadlines
- Discretion to know when to act independently and when to ask for guidance and/or assistance
- Excellent organizational skills and attention to detail
- Manage and maintain Companies' Website and Directory
- Adheres to all HIPPA Laws
- SCL Health is a healthcare organization that provides a range of services including hospital care and outpatient services
- Website: rmhn.org
Patient Service Representative
Avadyne Health
Billings, USA
03.2007 - 09.2017
- Company Overview: Avadyne Health is a healthcare revenue cycle management company that provides services to hospitals and healthcare providers
- Website: avadynehealth.com
- Worked in a call center that handles self-pay and third-party accounts for multiple out of state hospitals
- Responsible for taking inbound and making outbound calls for hospital billing offices
- My duties were but not limited to following very strict HIPAA guidelines, having exemplary communication skills and customer service, processed payments, set up payment plans, added insurance and demographic information, prequalify low-income patients for financial assistance, explain to patients how their insurance processed their medical claims, dealing with upset patients by diffusing their anger and making them happy by the end of the call
- Avadyne Health is a healthcare revenue cycle management company that provides services to hospitals and healthcare providers
- Website: avadynehealth.com
Business Office Representative / Systems Computer Analyst
Ortho Montana PSC
Billings, USA
05.1995 - 01.2004
- Company Overview: Ortho Montana PSC is a healthcare provider specializing in orthopedic care
- Website: montanabones.com
- Supervised and trained employees for business office and reception desk
- Excellent ten-key and data entry skills
- Strong knowledge in medical terminology, ICD9, CPT, modifiers, submission of HCFA forms and insurance guidelines
- Assisted patients with insurance problems, payment/payment plans
- Monitored accounts receivable, processed insurance and patient refunds
- As Systems Computer Analyst, entered charges, payments and preferred provider adjustments, processed end of day balance sheets and prepared daily bank deposit
- Ortho Montana PSC is a healthcare provider specializing in orthopedic care
- Website: montanabones.com
Education
High School -
Bakersfield High School
Skills
- Customer service expertise
- Documentation management
- Effective Organizational Skills
- Strong data entry skills
- Effective Deadline Management
- Provider enrollment process
- Teamwork and collaboration
- Workflow optimization
- Multi-tasker
- Roster skills
- Attention to detail
- Excellent phone demeanor
- Understanding of HIPAA Regulations
- Consistent Reliability
- Professional Email Communication
- Provider relations
- Interpersonal relations
- Decision making aptitude
Timeline
Provider Insurance Enrollment Specialist
Aspirus, Inc.
05.2021 - 11.2024
Provider Data Specialist
SCL Health - Rocky Mountain Health Network
01.2018 - 09.2021
Patient Service Representative
Avadyne Health
03.2007 - 09.2017
Business Office Representative / Systems Computer Analyst
Ortho Montana PSC
05.1995 - 01.2004
High School -
Bakersfield High School
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