Wendi Avant
Miami,FL
Summary
Healthcare Professional with 20 years’ experience in a healthcare setting knowledgeable in Provider Relations, Provider Contracts, Data Integrity, Credentialing and Claims, possessing in-depth knowledge of various insurance plans and policies. Expertise in handling high volume of calls, efficiently resolving disputes and identifying ways to improve processes. Well-versed in medical claim appeal processing, clinical relations. Problem solver and deliver innovative improvement strategies. Seeking to maintain a full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills. Seasoned and Proficient in all Microsoft Applications.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Senior Provider Relations Representative
Bright Healthcare
03.2021 - 12.2022
- Collaborate with Providers in the distribution of orientation and educational material to all levels of personnel within a hospital, ancillary services, or physician settings
- Resolved provider issues including claim submission, escalation, processing, and payment
- Support provider data integrity and through their credentialing/re-credentialing process to ensure correct ongoing collection of key provider data element updates and roster changes
- Analyzed, prepared, supported, and distributed various departmental reports, including specialized reports for providers or networks
Care Contracting and Credentialing Specialist
VITAS Healthcare Corporation
Miramar, Florida
07.2017 - 03.2021
- Completion of facility credentialing/re-credentialing applications and roster/data support
- Tracking all facility licenses and certifications for expirations and renewals
- Auditing health plan directories for current and correct provider demographic information
- Reviewing providers accreditation and certification requirements; OIG, SAMS, IRS, CMS, CLIA and State Board Certifications to ensure credentials are valid and up to date
- Involved in monitoring process improvements using key indicators (i.e., A/R adjustments, denials, prior authorizations, patient liability), and facilitate corrective action plan
Billing Resolution Specialist
VITAS Healthcare Corporation
Miramar, Florida
01.2017 - 07.2017
- Resolving Insurance Carrier rejections from clearinghouse, conducting quality reviews and working projects with EDI 835/837 reports
- Monitoring claims and financial clearance inquiries escalated to Payer Relations Department
- Researching and uploading Insurance provider manuals and bulletins to support up to date guidelines
- Working collaboratively with senior management to identify any negative impact on account receivables
Medicare and Medicaid Coordinator II
VITAS Healthcare Corporation
Miramar, Florida
08.2016 - 01.2017
- Coordinating with payor relations contracting department to resolve payer issues
- Adjusting and re-submitting claims via Health Plans web portals
- Reviewing aged trial balance (ATB) on a regular basis monitoring problems with accounts receivables
- Support to clinical team and case management by providing updated patient information as needed
- Responding to emails and letters from health plans regarding any member related issues
Workers Compensation Account Specialist
CORVEL/CARE IQ
Sunrise, Florida
09.2011 - 07.2016
- Processing of claims for Workers Compensation Managed Care Services
- Generating aging reports for DME, Home Health, Physical Therapy, Radiology and Transportation related claims on HCFA 1500 and UB92 claims forms
- Collaborating with claims adjusters and billing department on complex claims issues for resolution
- Communicating with case managers regarding complex cases that require further research
- Collaborating with claims adjusters to ensure reserves were applicable and available on patient accounts
- Medical Record request as needed for physician’s orders, cost invoice to review for reimbursement accuracy
- Training new hires in the department on company systems and department workflows
Client Account Specialist
DaVita Laboratory
Fort Lauderdale, Florida
04.2004 - 12.2011
- Verification of patient’s insurance information for all assigned facilities via provider portals
- Obtaining prior authorization based on the patient’s covered insurance plan
- Communicating regularly with the Facilities staff to obtain necessary information for billing insurance updates, ICD-9 code changes, requesting of medical records and new patient insurance demographic information
- Communicating payer related concerns discovered during insurance verification to the management teams
Collection Specialist
DaVita Laboratory
Fort Lauderdale, Florida
01.2000 - 04.2004
- Team leads for the Continuous Quality Improvement and Veterans Health Administration accounts
- Resolving aged claims achieving 80% reduction rate in department revenue on the VA assigned accounts
- Identifying potential adjustments, refunds, trends with insurance denials and underpayments
- Validating Government Payers information in the Direct Data Entry (DDE) and Media Fax systems
- Communicating with Social workers on all changes and updates to patient insurance
- Supporting Management with quality assurance (QA) spreadsheets, phone calls and e-mail requests
- Reconciling cash balances and posting receipts in the billing system and accounts receivable journals
Education
Health Information Management
University of Phoenix
10.2005
Skills
- SPECIAL SKILLS
- Microsoft Applications, Share Point, CAQH, Aperture, PeopleSoft, Bright Tree, Antrim, Reggie, Vx Billing System for Hospice, Boris, Quick Silver, Medicare System (DDE), Lab Scope, Medical Manager, E-Primis, Collaboration Compass, Relay Assurance, Apptus Salesforce, OIG and Sam Registration
Certification
Commissioned Notary: Commission# GG 313697
Signing Agent- NNA Certified
Adjuster-All Lines (0620): License# W196582
Timeline
Senior Provider Relations Representative
Bright Healthcare
03.2021 - 12.2022
Care Contracting and Credentialing Specialist
VITAS Healthcare Corporation
07.2017 - 03.2021
Billing Resolution Specialist
VITAS Healthcare Corporation
01.2017 - 07.2017
Medicare and Medicaid Coordinator II
VITAS Healthcare Corporation
08.2016 - 01.2017
Workers Compensation Account Specialist
CORVEL/CARE IQ
09.2011 - 07.2016
Client Account Specialist
DaVita Laboratory
04.2004 - 12.2011
Collection Specialist
DaVita Laboratory
01.2000 - 04.2004
Health Information Management
University of Phoenix
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