• Receives and processes incoming applications and supporting credentials from providers• Performs timely follow-up with providers on all pending applications• Performs the primary source verification according to departmental policies and NCQA standards when not completed by CVO• Builds and accurately maintains provider information in various systems• Performs Quality Assurance of all provider credentialing information in preparation for committee(s)• Responds to inquiries regarding the status of provider’s application• Utilizes organizational templates to communicate with providers about the status of their application with the organization• Provides support to Credentialing Specialist I on functional responsibilities• Interview credentialing candidates• Trains credentialing specialists

Maintain client database and ensure updated Accounts Receivable outreach for past due invoicesImport & upload client documents, updating naming convention as neededResearch and handle phone correspondence setup & inquiries

• Manage tasks for President/CEO, Vice President/COO, Project Manager and Senior Strategist• Manage schedule and calendars for President/CEO and advise of conflicts• Review high importance and flagged emails for President/CEO to ensure timely responses• Provide research as needed for President/CEO • Track and upload invoices for timely processing by Vice President/COO• Ensure all Labor posting requirements are met for Vice President/COO• Review Benefit plans packages offered and Background check company offerings for Vice President/COO• Review Onboarding processes and procedures in place for Vice President/COO• Review Bill Payment options for Vice President/COO • Manage Recruitment for Grant and Proposal projects including drafting position descriptions and screening questions, posting positions and screening questions, pre-screening candidates and coordinating interviews • Format resumes for Grant and Proposal projects • Provide lodging and equipment quotes for Grant and Proposal projects • Draft Commitment and Contingent Offer Letters for Grant and Proposal projects

• Act as POC for president• Review products and provide feedback for clients for continuous quality improvement• Handle administrative needs for president• Manage work and personal schedules and calendars• Assist with travel and personal obligations• Manage recruitment • Provide Professional Training Development research and update company website with Course offerings• Administrative support• Scheduling assistance• Research products and services• Act as liaison for president with business partners, clients, board members, etc.• Ensure timely response from board members

• Act as liaison and POC for president• Manage schedule and calendars• Manage Grant and Proposal projects • Coordinate collaborations with writers, clients and president• Manage hiring, timekeeping and payroll • Ensure deadlines are met by all parties involved• Review to ensure product meets government agency requirements• Assist with travel and personal obligations• Administrative support• Scheduling assistance• Research products, services, clients and potential revenue• Act as liaison for president with business partners, clients, contractors, etc.• Handle Accounts Payable & Receivable• Ensure timely response from staff

• Presented program to potential network contractors via telephone; including cold calls, following up on referrals/leads• Sent marketing materials and applications to prospective contractors related to programs• Documented call progress on productivity report and in automated systems• Utilized various software programs to locate contractor information and document contractor information• Analyzed areas of need for contractor network coverage• Took part in developing new strategies for recruiting contractors• Interacted with clients regarding contractor recruiting and selections• Participated in special projects or performs duties in other areas as requested• Upheld and projects the public image of the company

• Maintained high quality, timely and accurate credentialing processes of medical and allied healthcare professionals per CPC policy and procedure• Assisted in the credentialing process by entering/logging/scanning information into credentialing system for initial, updated, add on applications and maintenance processes• Acted as liaison with MSO as point person for completing and ensuring compliance and delivery of required information to clients in a timely manner• Pursued incomplete information• Assured confidentiality of data• Processed and maintain credentialing and re-credentialing in accordance with CPC policy and procedure, Joint Commission standards, State and Federal Regulatory regulations.This will include but not limited to the following verifications:National Practitioner Data Bank OIG/GSA for Medicare/Medicaid exemptionDEA Verification LicensureBoard Certification Training verified. Residency/ FellowshipPeer Recommendation Professional Schooling Verified• Ensured that all credentials’ files are current and complete pursuant to expiration date of medical licenses, board certification, professional-liability insurance coverage, DEA and other pertinent information, per CPC policy and procedure

• Monitored collection of all information received; follow up on missing items and/or incomplete forms per CPC policy and procedure, submit follow up requests for verifications as needed• Identified and evaluates potential red flags and works in collaboration with practitioner to document the issue and physician response• Advised Manager and/or Director of questionable information received, and any issues identified during the processes• Submitted closed files for audit/final review and secure missing items as identified by audit/final review• Maintained all credentials files ensuring that all correspondence in the credentialing and reappointment process is accurately filed; is knowledgeable and current on the process and legal/regulatory requirements• Compliant with HCA policy and procedure, Federal and State regulatory and accrediting agencies as required• Performed other duties and works on special projects as requested• Practiced and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”• Performed other duties as assigned• Processed and maintained credentialing and recredentialing in accordance with CPC policy and procedure, Joint Commission standards, State and Federal Regulatory regulations including: DEA Verification, Board Certification and Licensure• Ensured that all credentials’ files are current and complete pursuant to expiration date of medical licenses, board certification, DEA and other pertinent information, per CPC policy• Submitted and reviewed background checks• Pursued incomplete information• Assured confidentiality of data

Verify insuranceEnter chargesSchedule appointmentsCollectionsIT

Resolve emailed client emailed inquiries via support mailboxAnswer calls and resolve client concernsProcess Electronic Remittance Advice enrollments and update formsResolve 270/271, 276/277. 278, 835, 837P/837I inquiries and issuesTrain and update Electronic Remittance Advice enrollments policies and proceduresResolve manager and lead Electronic Remittance Advice enrollments inquiries and issuesProvide continual payer list updatesUpdate clients timely with open ticket statuses and resolutionsClarify Electronic Data Interchange data for re-submissionAssist with and process Electronic Data Interchange enrollments

• Excelled in customer service • Answered calls and resolved member’s concerns • Processed cancellation and customer service surveys

• Answered phones and scheduled appointments • Assisted Recruiters in obtaining new students/leads • Counseled students on course work and requirements

• Made sure patients were compliant with treatment • Updated adjusters and nurse case managers of patient’s progression with treatment • Maintained organizational, time management and multitasking skills and am detail oriented • Assisted with CQI report for better understanding of procedures

• Performed financial transactions and resolved member’s concerns • Balanced ATMs and cash dispenser • Performed audits on ATMs, Cash dispensers, teller drawers and teller’s work

• Excelled in customer service • Performed prep work • Stocked shelves

• Answered phones and scheduled appointments • Handled petty cash, co-pays and deductibles • Verified all billing codes for correct processing

• Verified benefits and eligibility • Handled over 200 personal injury, insurance and workers compensation patients a week • Explained Explanation Of Benefits to patients and deductible information

• Processed payroll • Handled accounts payable and receivable • Dispatched and provided directions to calls

• Resolved member’s concerns • Performed financial transactions as well as inform them of products and services offered • Balanced ATMs, vault and cash dispenser • Balanced cash drawer