Nichole Logan Email & Phone Number

Manage and oversee the initial credentialing process for new providers joining the company. Create and build providers credentialing files. Maintain as the primary point of contact to all parties throughout entire process of providers credentialing. Gathers and prepares all required documents needing completion from provider. Coordinate and track process of completing paperwork with provider to guarantee deadlines are met returning needed documents. Complete quality reviews on all applications and documents received from providers for accuracy and completeness of all information required. Continuously auditing and reviewing files to ensure all required documentation or additional items requested are diligently returned and submitted into verification office. Ensure all licenses and certifications are current and on file for each provider, such as, state licensures, DEA, Board certifications, ACLS, ATLS and PALS certifications, etc. Functions as a liaison, coordinating with both the CVO office as well as the hospital’s medical staff to successfully finalize the privileging process. Guaranteeing the provider will be granted privileges by deadline needed and approved according to the Medical Staff By-Laws, Rules & Regulations, general hospital policies and procedures, and other regulations governing the Medical Staff.Maintain and update information for all providers for the physician data base as needed or requested.Prepare and coordinate audits and/or special projects independently when assigned.Maintain confidentiality with all documents and information working with.

Scottsdale, Az

Generate and distribute Facility Rounding reports to over 100+ Clinical Providers throughout the country daily. Guaranteeing Clinical Operations has the most precise and valuable information available to achieve production goals.Accurately compile and record receipt of secure electronic membership data received from approximately 25 Health Insurance Clients.Upload all membership files into system, confirming successful processing. When needed, analyze data to determine source of discrepancies.Conduct audits on files received and processed, comparing against data distributed ensuring minimal missed opportunities for Clinical. Document, process and file daily production outcomes e-mailed from Clinical Providers.Provide member eligibility verification requested from Clinical Operations. Analyze production volumes against provider assignments ensuring all providers have sufficient work available. Make Facility assignment changes when needed. Research, troubleshoot and correct any Facility related issues; assignments, membership volume, billing.

Phoenix,Az

Process first report of loss claims. Assist claims adjuster with inquiry calls from various parties involved within a claim; Insured, Claimants, Witnesses, Agents etc. Via phone communication, accurately process and route new insurance claims reported. Worked all lines of business, Personal as well as Commercial consisting of Auto, Property, General Liability and Workers Compensation Insurance.Through electronic data transfer, EDI, diligently verified and confirmed all data on the FROI, first report of incident received was transfered over through EDI properly. In addition confirm all sufficient information required for processing new claims was provided.Submit new claims with extreme detail, ensuring claim has been routed to correct claim unit, adjuster. When situations were applicable escalated files, gaurenteeing direct contact was made from adjuster immediately. Fax Coordinator Lead-Managed production volume of all EDI claims received. Categorized, prioritized and assigned out work assignments of claims needing processed to fellow co-workers. Consistently monitoring assignments and volumes, making any changes needed. Reassign or adjust assignments to guarantee all claims are processed within the proper handling time frame.In addition to coaching peers, also taught and trained orientation class for new CSR employees. Provided knowledge and tips to enhance job performances. Responsible for answering the "help line" which was internal line coworkers would call if even needed assistance during a call.Recorded and logged all updates and/or changes on all Job Aids and Quick Reference manuals.

Phoenix, Arizona Area

Managed accounts in assignment ensuring continuous on-schedule task manager with high production results. Review, manage and negotiate acceptable payments from delinquent account holders which require special handling and review outside of auto dialer.Document precise notations on actions taken pertaining to each accounts and actions taken.Sufficiently research and utilize the most cost effective and successful methods of skip tracing , such as credit bureaus, yellow pages and public documents available to obtain pertinent information needed.In end result, process accounts for legal action to be taken. Pursue legal requirements needed in filling judgments against cardholders.