Norma Young Email & Phone Number

Houston, Tx, Us

Houston, Texas

Payor Credentialing: Initiate and maintain to completion credentialing and recredentialing for all physicians/practice for all Managed care contracts including government contracts (Medicaid and Medicare). Solve issues related to provider enrollment. Submit EDI, ERA AND EFT enrollment to all carriers. Maintain copies of current state license, DEA certificates, malpractice coverage and other required credentialing documents for all providers. Maintain provider portals and provider id’s. Update… Show more Payor Credentialing: Initiate and maintain to completion credentialing and recredentialing for all physicians/practice for all Managed care contracts including government contracts (Medicaid and Medicare). Solve issues related to provider enrollment. Submit EDI, ERA AND EFT enrollment to all carriers. Maintain copies of current state license, DEA certificates, malpractice coverage and other required credentialing documents for all providers. Maintain provider portals and provider id’s. Update provider profile as changes are made in my database. Forward updated enrollment data to billing for integration into the billing system. Scan all applications and all attachments prior to mailing original. Ensures timely renewal of hospital privileges. Accept and process requests from payers for credentialing information follow up in timely manner. Development of credentialing forms letters and reports . Conduct sanctions and compliance monitoring and alert management of any undisclosed findings immediately. Maintain CAQH profile for each physician; complete review and re-attestation of information as needed. Compliance with HIPAA. Audit health plan directories for current and accurate physician/practice info.Payor Collections: Monitor aging reports demonstrate the ability to improve collections. Review of ERA for claims resolutions, follow up on unpaid/under paid claims cteating appeals as needed ensuring that processes are followed to obtaining full payment. Moderate coding corrections and claim re-submissions. Contacts third party payer’s for issues, expedite claims processing and maximize timely reimbursement. Works with adjusters and attorneys for claims resolutions. Respond to correspondencefrom carriers to facilitate payment. Patient’s insurance eligibility and benefit verification. Understands managed care authorizations and limits to coverage. Post insurance payments using claim billing software. Maintain detailed and accurate account documentation. Show less