Reporting Analyst, Credentialing Specialist

As Accountable Specialist my main role is to ensure that all claims submitted will be paid and posted on the timely manners. I am also responsible in calling insurance to check on claim status submitted and check on the reason for the claims that has been denied. And lastly, I am also responsible in posting payment forwarded to us.

Knowledgeable in using Microsoft Excel, creating formulas and graph from scratch. I can turn it into high level management data.

Clarifies and verifies details of insurance coverage with private or government carriers and offers information to patients before medical services are provided. Tracks physician referrals and provides necessary details to billing staff.

Preparing and submitting billing data and medical claims to insurance companies. Ensuring each patient's medical information is accurate and up to date. Preparing bills and invoices and document amounts due to medical procedures and services. Secure outstanding balance payments for care of employees Utilize collection agencies and small claims courts to collect accounts by evaluating and selecting collection agencies, determining the appropriateness of pursuing legal remedies and testifies in court cases, when necessary Generate revenue by making payment arrangements, collecting accounts and monitoring and pursuing delinquent accounts Collect delinquent accounts by establishing payment arrangements with patients, monitoring payments and following up with patients when payment lapses

Key Responsibilities • Manage the full credentialing process, including initial credentialing, re-credentialing, and privileging. • Verify provider qualifications, including licenses, certifications, malpractice insurance, and continuing education. • Coordinate with providers to collect and submit necessary documents to insurance companies. • Work with insurance companies and CAQH to facilitate provider enrollment. • Ensure compliance with NCQA, URAC, HIPAA, and mental health accreditation standards. • Communicate with providers regarding credentialing status, documentation needs, and follow-ups. • Track expiration dates for licenses, certifications, and insurance contracts to ensure timely renewals. • Support audits and compliance reviews to maintain credentialing accuracy.