Tayona White

• N oConducted primary source verifications such as background checks and board certifications.
• Received and evaluated applications to look for missing and inaccurate information.
• Prepared records for site visits and file audits.
• Enrolled providers into government and commercial plans such as Medicaid, Medicare, Blue Cross Blue Shield , and Aetna.
• Assisting with provider access to their assigned region.
• Assisting with the submission and preparation of credential files for timely submission for the committee review and approval .
• Conducting a thorough review of provider credentials ensuring completion and accuracy.
• Assist with system portal updates. Providing internal and external access to Headquarters files.
• Staying abreast of all compliance regulations.
• Resolving any all discrepancies within my region.
• Managed a region of over 400 plus providers credentialing anywhere from 10 plus providers per day.

• Followed safety protocols while handling hazardous materials.
• Assisted scientists by collecting and organizing laboratory data.
• Kept abreast of current industry, scientific and regulatory developments and issues.
• Trained and supervised junior technicians in laboratory protocols.
• Prepared samples for analysis by performing complex sample preparation tasks.
• Recorded and analyzed data to produce reports of results.
• Developed new protocols and improved existing laboratory processes.
• Inspecting every specimen received to ensure minimal errors during processing.
• Keeping data entry rate under 2%.

Kept medical supplies in sufficient stock by monitoring levels and submitting replenishment orders before they were depleted.

• Sanitized, restocked, and organized exam rooms and medical equipment.
• Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
• Obtained client medical history, medication information, symptoms, and allergies.
• Screened and scheduled appointments for up to 10 providers.
• Coordinated patient scheduling, check-in, check-out, and billing payments.
• Received, recorded, and filed medical payments by check, cash, and credit card.
• Gathered forms and copied insurance cards to collect patient information for billing and insurance filing.
• Prepared patient charts by gathering and organizing medical records ahead of appointments.
• Reconciled daily payments received and prepared deposits for smooth office finances.
• Obtained pre-authorization from insurance companies before medical services.
• Registered patients and completed associated paperwork for accurate records.
• Managed office bookkeeping with insurance billing and patient payments.
• Processed medical insurance claims and payments.

• Correctly coded and billed medical claims for various hospital and nursing facilities.
• Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
• Utilized active listening, interpersonal, and telephone etiquette skills when communicating with others.
• Verified signatures and checked medical charts for accuracy and completion.
• Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
• Generated reports to identify coding trends and discrepancies.
• Communicated with insurance companies to research and resolved coding discrepancies.
• Monitored changes in coding regulations to provide recommendations for compliance.
• Followed exact procedures for handling transfers and other releases of medical records.
• Followed up with medical staff regarding missing information in patient records.
• Sorted and distributed incoming and outgoing medical records.
• Tracked and monitored requests for medical records release.
• Transcribed and entered patient medical information into electronic medical records systems.
• Developed and implemented new filing system for medical records to improve efficiency.
• Prepared billing statements for patients and verified correct diagnostic coding.
• Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
• Posted payments and collections on regular basis.
• Communicated with insurance providers to resolve denied claims and resubmitted.
• Verified insurance of patients to determine eligibility.
• Kept vendor files accurate and up-to-date to expedite payment processing.
• Verified accuracy of accounts payable payments, resulting in 15% reduction in payment errors and check reissues.

• Reviewed patient records, medications and immunization statuses.
• Created and managed electronic patient records, encompassing data entry and administrative functions related to insurance, billing, and accounts receivable.
• Maintained organized, comprehensive patient records for assigned caseload.
• Screened patient records, databases, and physician referrals to identify prospective candidates for research studies.
• Focusing on managing claims denials and timely reimbursement.
• Analyzing the reason for claim denials for future prevention
• Processing claims for services rendered according to CPT and ICD-9/10 codes.