• Performed data analysis on provider request to ensure all data elements were present for loading.• Processed adds, updates and termination for new or existing provider records in Portico.• Credentialed and re-credentialed providers for network participation based on NCQA guidelines.• Processed, tracked and filed credentialing applications within established standards.• Interacted with other operational units to resolve escalated issues.• Pulled providers profiles from the GAMMIS web portal for system updates.• Created Medicaid, Medicare and Exchange affiliation for interfacing into AMISYS.

• Responded to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility and claims.• Used excel spreadsheets for provider data to use and send over to the credentialing department. • Analyzed problems and provides information/solutions.• Operated a PC/image station to obtain and extract information, documents information, activities and changes in the database.• Thoroughly documented inquiry outcomes for accurate tracking and analysis. • Developed and maintained positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.• Researched and analyzed data to address operational challenges and customer service issues.• Provided external and internal customers with requested information.• Used computerized systems for tracking, information gathering and troubleshooting.

* Provided superior customer service to clients, Agencies and Facilities.* Served as Liaison between Transportation Companies and Patients to provide medicaltransportation.* Answered inbound calls regarding Non-Emergency Medical Transportation for Medicaid recipients.* Efficient and accurate entering of required data into Logisticare's data management system.* Performed all gatekeeping functions related to trip authorization.* Documented and resolved complaints and issues.* Scheduled standing appointments for members and resolved scheduling issues via telephone andonline scheduling systems.* Route calls to proper department.