Chelsea Bean
York
Summary
Credentialing professional with expertise in managing and streamlining credentialing processes. Strong focus on compliance, accuracy, and timely completion of credentialing tasks. Effective in team collaboration, known for adaptability and reliability. Proficient in database management and policy implementation. Adept at conducting application reviews and primary source verifications. Excellent relationship-building, problem-solving and communication skills with a Bachelor's degree focused in Health Information Management from Rasmussen University.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Credentialing Specialist T3
Quadris Team, LLC
07.2023 - Current
- Oversee nine contracts for multi-specialty clinics and facilities. Including over 100 payers, 220 medical professionals, and 7 states.
- Recruit and hire qualified candidates to fill open positions. Direct and supervise credentialing team to ensure high performance and quality for all clients.
- Conduct thorough primary source verifications, ensuring accuracy and validity of physician qualifications.
- Monitor expiration dates on licenses, certifications, and insurance policies, proactively preventing lapses in coverage or compliance issues.
- Coordinate with various departments to obtain necessary documentation for credentialing processes, promoting seamless collaboration.
- Assist in the training of new team members on credentialing processes and procedures, ensuring a smooth transition for incoming personnel.
- Complete and process applications for enrollment.
Review and research contracts to prepare for negotiations of fee schedules. - Address requests, overseeing compliance with governmental and organizational guidelines regarding tiered data access.
Collaborate with insurance companies to ascertain pertinent information regarding policies and payment benefits for patients. - Enhance data accuracy by reviewing and updating credentialing databases.
- Coordinate and plan investigations of claims to confirm compensability and coverage.
Credentialing Specialist T2
Quadris Team, LLC
02.2023 - 07.2023
- Coordinated with healthcare providers to resolve discrepancies in submitted documentation.
- Completed provider and facility payer initial and re-credentialing applications while responding to request in a timely manner.
- Organized credentialing information by reviewing, entering, and following up on missing information.
- Managed a contract covering over 50 medical professionals and 15 insurance payers.
- Established a professional relationship with providers, insurance representatives, and client contacts.
- Collected, uploaded, and audited medical professional documentation including resume, liability insurance, diplomas, and certifications.
- Verified and submitted CAQH profile data with supporting documents; facilitate provider attestation of data as required by CAQH and payers.
- Guaranteed all PHI is kept secure and maintained compliance.
Provider Enrollment Rep II
Noridian Healthcare Solutions, LLC
04.2022 - 09.2022
- Conducted tracking and follow-ups to ensure providers were established and linked to the appropriate group entity.
- Strengthened compliance efforts by staying up-to-date on industry regulations and applying them accurately throughout the enrollment process.
- Assisted in training new team members, sharing knowledge and expertise to help build a more effective workforce.
- Volunteered to help with additional tasks needed for team goals to be reached, while maintaining quality and quantity in regulation with CMS.
- Provided strong verbal and written skills to guarantee excellent customer service.
- Assisted with special projects including PECOS 2.0 development and Mentoring Program.
- Planned, arranged, and facilitated mentoring activities for new team members to ensure individual and team expectations were met.
Provider Enrollment Rep I
Noridian Healthcare Solutions, LLC
04.2021 - 04.2022
- Processed Medicare Part B enrollments, changes, and terminations for individuals, groups, critical access hospitals, and physician assistants, Knowledgeable in both web and paper applications.
- Operated systems such as SAM, NPPES, OIG, and others to verify and update provider information.
- Maintained consistent contact with providers and office management to ensure expectations are clear and requirements are completed in a timely manner.
- Used professional knowledge, critical thinking, and problem-solving skills to establish rapport, resolve issues, and guarantee a positive experience.
Independent Distributor
Alien Feet
09.2013 - 11.2014
- Corresponded with the CEO/owner of Alien Feet to collaborate on sales and marketing ideas.
- Developed reports, invoices, memos, and financial statements.
- Created positive relationships with local accounts.
- Clarified customer concerns and questions via phone or emails.
Medical Administrative Assistant
Mount Vernon Internal Medicine
02.2012 - 09.2013
- Verified insurance and processed co-payments/co-insurance to patient's accounts.
- Collected, prepared, and scanned medical records into EMR. Trained in Allscripts and Phreesia.
- Utilized knowledge of medical terminology, procedures, and ICD-10 to prepare patient's charts.
- Obtained prior authorization from respective insurance companies for specialty services, surgeries, and DME.
- Authorized treatments for worker’s comp claims.
Education
Bachelor of Science - Health Information Management
Rasmussen University
03-2021
Associate of Science - Health Information Technology
Rasmussen University
09-2017
Skills
- PECOS
- CAQH
- Microsoft Office
- MD Staff
- Medicare Part B
- Medicaid
- DME
- Managed Care Plans
- IPAs/CINs
- Contract Negotiations
- Provider enrollment
- Credentialing processes
Certification
- RHIA - Registered Health Information Administrator - AHIMA - Eligible
- PESC - Provider Enrollment Specialist Certificate- January 2024
Timeline
Credentialing Specialist T3
Quadris Team, LLC
07.2023 - Current
Credentialing Specialist T2
Quadris Team, LLC
02.2023 - 07.2023
Provider Enrollment Rep II
Noridian Healthcare Solutions, LLC
04.2022 - 09.2022
Provider Enrollment Rep I
Noridian Healthcare Solutions, LLC
04.2021 - 04.2022
Independent Distributor
Alien Feet
09.2013 - 11.2014
Medical Administrative Assistant
Mount Vernon Internal Medicine
02.2012 - 09.2013
Bachelor of Science - Health Information Management
Rasmussen University
Associate of Science - Health Information Technology
Rasmussen University
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