An experienced, self-motivated and results oriented employee, with over six years of extensive involvement with Medicaid. Redesigned problem-solving skills.
I have strong effective communication skills and strong analytical decision & making skills. Ability to work professionally and efficiently in a team environment. Seeking a challenging, full-time position where I can apply my education and experience to add value to this corporation.
Build and review medical case records received via fax from inpatient rehab, obstetrician, and outpatient therapy providers •Coordinate follow-up peer to peer reviews • Identify barriers to plan compliance and coordinate resolutions • Prepares reports and document all actions.
Provide direction on the credentialing procedure and respond to inquiries from providers regarding their applications • Participate in department efforts to enhance quality •Examine the practitioner’s application and other supporting materials to determine eligibility • Maintain performance and quality standards based on established dept. metrics • Research and identify any processing inaccuracies and route to the appropriate site operations team.
Education
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