Tabitha Wolford Email & Phone Number

-Responsible for overseeing a team of 30+ for Provider Data Management/Network Operations/Credentialing/Auditing staff that maintains strong relationships with network providers and health plans-Interact with providers, health plans, hospitals and regulatory agencies to resolve provider network issues-Oversees Health Plan Adds, Delegated credentialing, auditing, provider demographic changes, and Terminations-Build solutions to maximize workflows in operations and eliminate backlogs resulting in peak performance-Championed new policies and regulations to increase productivity, quality and TATs

-Lead team to promote professional development and build provider rapport by training and mentoring representatives achieving 75% employee retention-Function as first point of escalation and manage strategic relationships in MCAID/MCARE/Commercial lines of business for multiple states-Build and increase network retention by direct provider engagement and training, offices visits, state conferences, facility reviews and network adequacy monitoring-Improve provider network capabilities by offering training and coaching for self-sufficient platforms and provider portal features-Investigate and achieve resolution for: claims, portal access, network availability, network encounter files, state master files, GEO access, fee schedules, health plan requirements, credentialing, and member access for Medicare/Medicaid/Commercial lines of business

-Coach, mentor, and built training for new and existing employees as well as manage a team of 6 accounts receivable specialists.-Maintain monthly meetings and develop rapport with new and existing clients.-Analyze trends in client billing and insurance claim denials to advise clients on practice improvement and provide on-site training to their staff in workflows and best practices to promote prompt payment.-Responsible for client’s portfolios ranging from $5M to $8M.-Multi-task through several different healthcare databases with ease.-Communicate effectively within a team setting.

Researched and resolved EOB Rejections, incorrect payments, and other issues with outstanding accounts.Reviewed billing edits and provided insurance providers with correct information.Improved A/R by 90% by creating templates to track claims submitted past 180 days.

Improved company sales by 73% through client follow-up and up-sales.Serviced existing accounts, obtain orders and established new accounts by planning and organizing daily work schedules.Tracked and managed Inventory and Warehouse Management.Managed and trained a team to ensure rapid customer turnaround.Promote long-term goal of customer's loyalty and satisfaction.

Responsible for collecting and posting over $100,000 in insurance payments to patient accounts.Assist IT Department with Software and Hardware troubleshooting.Achieved maintaining A/R under 30 days by processing claims timely, and obtained authorizations and submitted original and amended claims to proper insurance companies.