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Yyyyyy x. yyyyyy

560 North 2nd Street, #110 Xxxxxx, XXXXXX xxxxxx (xxx-xxx-xxxx


  • Dynamic Leader who offers a background in Credentialing, Contracting, Multi-Project Management, Account Management, Policy / Procedure Development, Six Sigma, Process Improvement, and Customer Service with proven specializations in Healthcare, Health Information Management, Insurance, Authorizations, and Billing / Coding.
  • Top Performer who boasts above-average career results, and who can make decisions to reflect positively on operations in alignment with a company s vision, value, and goals to attain a significant competitive advantage.
  • Excellent Communicator who builds synergistic relationships with administrators, healthcare professionals, insurance companies, patients, customers, and the public and who excels in autonomous and collaborative work environments.


Professional Synopsis


Funding Coordinator Lead Credentialing & Contractual Specialist Xxxxxx Adult & Teen Challenge 2015 Present


  Capitalize on the opportunity to handle high-volume administrative management of current provider credentials prior to revalidation, including updating MCC website with licenses and liability insurance, as well as sending reminders for renewals and disseminating paperwork for all facility changes, program changes, and provider updates.

  Direct duties of funding coordinators, including ensuring prompt and accurate intakes, discharges, and authorizations and guaranteeing that spreadsheets are up-to-date and resolving errors for billing to be handled without any issues.

  Liaise among LADC counselors, mental health professionals, and billing for current clients regarding funding efforts.


  Spearheaded multi-site satellite training for all staff using Procentive.

  Expertly handled billing of outpatient services and residential clients monthly.

  Developed process for Funding Coordinator duties, and trained staff in key responsibilities.

  Collaborated with contractual representatives while overseeing network insurance contracts.

  Created XXXXXXTC employee access in insurance portals, along with setting up new client information.

  Responsible for leading a focus group for ICD-10 denials during the ICD-10 change that took effect in 2015.

  Developed weekly reports for client funding status, and developed monthly reports for client insurance changes.


Insurance & Authorization Specialist Fairview Home Care & Hospice 2014 2015


  Strategically steered verification of insurance per Medicare packet information, including entering coverage information into Horizon and setting up follow-up notes, as well as sending clinical documentation for authorizations.

  Proactively communicated among unit nurse, case manager, customer service, and billing up until patient discharge.


  Demonstrated experience in requesting and receiving authorizations on XXXXXXITS for MA patients.


Systems Specialist University of Xxxxxx Fairview Health Services 2010 2014


  Managed telephone lines for FUD, Amplatz, and physician, including ensured providers were connected to proper services.

  Facilitated essential consults that came through for UMMC (East, West, and Amplatz banks), FRH, and FSH; paged the on-call physicians when necessary; assigned them to the proper facility and service; and ran patient-specific reports.

  Supported Fairview partnered insurances (i.e. Medica Harmony, Medica Health Advantage, and Fairview Preferred One) and responded to questions regarding insurance, as well as coverage, facilities, billing, appointments, and support.


  Efficiently managed online / web requests within a 2-hour window.

  Successfully piloted Revation a computer-based phone system with video.

  Consistently recognized as a Top Representative to handle calls and facilitate web requests.

  Responded to a MyChart support line to assist patients in creating and managing MyChart accounts.


Abstractor Health Information Management Xxxxxx Gastroenterology 2004 2010


  Played a vital role in accurately pulling hard copy hospital visits from Epic listed on a provider s census sheet, along with attaining high-volume orders from multi-site care to efficiently scan into EMR and ICS to appropriately file / label.

  Ensured visits were filed appropriately in the chart and online, and obtained records from patients primaries to scan.


  Served as the go-to trainer / preceptor for the department to meet critical goals.

  Developed and set out detailed meeting minutes to boost operations communications.

  Streamlined key recordkeeping by purging old records across a 7-year period for XXXXXXGI.


Education & Technical Summary


Associate s Degree in Advertising Design Xxxxxx School of Business Globe University


Microsoft Office Suite MCC HCQA BHP I Fairview Healthia Healthcare Insurance Portals ICS

Procentive Epic: Clinical / Hospital Horizon EMR CECC Revation Citrix RightFax Lotus Notes

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