Kristin Johnson
Belton,Missouri
Summary
Dedicated customer service specialist with expertise in medical administrative procedures. Seeking to enhance skills and excel in a new role. Skilled work-from-home (WFH) agent experienced in processing client-specific data with a strong commitment to maintaining confidentiality standards.
Results-oriented achiever with proven ability to exceed targets and drive success in fast-paced environments. Combines strategic thinking with hands-on experience to deliver impactful solutions and enhance organizational performance.
Overview
14
14
years of professional experience
Work History
Credentialer
Lucet
08.2023 - Current
- Supported credentialing processes by verifying provider qualifications and ensuring compliance with regulatory standards.
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Assisted in maintaining accurate databases of healthcare providers and their credentials for easy access.
- Coordinated communication between providers and internal teams to expedite credentialing workflows.
- Monitored ongoing compliance of providers with state and federal regulations through regular audits of documentation.
- Collaborated with cross-functional teams to improve credentialing procedures, ensuring faster turnaround times for approvals.
- Maintained up-to-date knowledge of industry trends in credentialing practices to support organizational improvements.
- Strengthened relationships with external agencies by responding promptly to verification requests and inquiries regarding providers'' credentials.
- Tracked expiration dates on documents and communicated with appropriate staff to avoid late filing.
- Elevated client satisfaction rates through prompt resolution of any provider-related issues or concerns that arose during the credentialing process.
- Ensured smooth communication flow between departments by acting as a liaison between medical staff services and other administrative units.
- Worked closely with practitioners to help each obtain privileges at assigned healthcare facilities
- Upheld strict confidentiality standards, safeguarding sensitive provider information from unauthorized access or disclosure.
- Assisted in maintaining accreditation status by preparing necessary reports and materials for site visits and audits.
- Maintained accurate files, records and credentialing documents in well-maintained databases using Certify.
- Conducted primary source verifications such as background checks and board certifications.
- Obtained NPI numbers for providers and facilities and updated existing profiles.
- Identified gaps in existing compliance processes and recommended updates.
- Collected detailed notes on investigations and other communication to adhere to legal requirements and enhance recordkeeping.
- Developed and implemented corrective action plans for non-compliance issues.
- Maintained composure in stressful situations, confrontations, interviews and records searches.
- Kept informed regarding pending industry changes, trends or best practices.
- Warned violators of infractions or penalties.
- Confirmed data and licensing information through investigations and notified violators of required changes to bring operations into compliance.
Provider Relations Specialist
Lucet
09.2021 - 08.2023
- Coordinated with insurance companies to process claims and resolve issues.
- Trained and supervised pharmacy technicians in daily operations and customer service.
- Facilitated communication between providers and internal teams to resolve issues promptly.
- Assisted in onboarding new healthcare providers, ensuring compliance with company policies.
- Managed provider inquiries and concerns through effective problem-solving techniques.
- Conducted regular updates to maintain accurate provider information in databases.
- Collaborated with claims department to address provider billing discrepancies efficiently.
- Developed educational materials to enhance provider understanding of services offered.
- Monitored provider satisfaction metrics, identifying areas for improvement in service delivery.
- Assisted providers in navigating through various reimbursement processes, resulting in timely payments and reduced financial disputes between parties.
- Strengthened provider networks through regular outreach and relationship building activities.
- Served as a liaison between healthcare organizations and insurance companies to ensure seamless communication regarding claims processing and payment matters.
- Managed high-volume caseloads of dispute resolution cases, providing swift resolutions that maintained positive relationships with both parties involved.
- Answered provider inquiries via email, telephone and written correspondence.
- Fostered strong, positive relationships with key providers by coordinating, facilitating and leading partnership meetings and identifying on-site enrollment opportunities.
- Developed comprehensive training materials for new Provider Relations Representatives, facilitating a smooth transition into their roles.
- Participated in cross-functional teams tasked with improving overall performance metrics within the organization''s Provider Relations department.
- Collaborated with internal departments to resolve complex provider issues, maintaining positive relationships and open communication channels.
- Provided exceptional customer service when working directly with healthcare professionals, establishing a reputation as a trusted resource for assistance.
Referral Specialist
Apex Systems
01.2022 - 06.2022
- Coordinated patient referrals to ensure timely access to specialists and services
- Managed referral documentation utilizing electronic health record systems
- Streamlined communication between healthcare providers and patients to enhance service delivery
- Analyzed referral patterns to identify opportunities for process improvements
- Collaborated with multidisciplinary teams to optimize patient care pathways
- Called insurance companies to get precertification and other benefits information on behalf of patients.
- Collaborated with healthcare providers to ensure accurate and complete referral information, improving patient care coordination.
- Streamlined referral processes for increased efficiency, resulting in timely appointments for patients.
- Developed strong relationships with external healthcare facilities, fostering a collaborative approach to patient care coordination.
- Maintained accurate records on in-progress and completed referrals, ensuring full data integrity throughout process.
- Managed high-volume referral requests by prioritizing tasks and maintaining organized records.
- Enhanced patient satisfaction by promptly addressing inquiries and resolving issues related to referrals.
- Reduced wait times for specialist appointments by diligently following up on pending referrals.
PRE REGISTRATION SPECIALIST
Saint Lukes Health System
11.2011 - 06.2020
- Managed patient registration processes, ensuring accuracy and efficiency in data entry.
- Provided exceptional customer service, resolving inquiries and issues promptly to enhance patient experience.
- Streamlined workflows by implementing best practices for document collection and verification procedures.
- Collaborated with healthcare teams to coordinate patient information and appointment scheduling effectively.
- Utilized electronic health record (EHR) systems to maintain up-to-date patient records and ensure compliance.
- Analyzed registration data to identify trends and recommend improvements for operational efficiency.
- Developed training materials for staff, enhancing understanding of regulatory requirements and registration processes.
- Enhanced patient registration accuracy by diligently reviewing and verifying information on registration forms.
- Managed high-volume workloads while consistently meeting deadlines for processing registrations and updating records.
- Worked with clinical staff, coding coordinators and billing department to resolve patient inquiries, billing, and coding questions.
- Reduced errors in patient records by implementing a double-check system for data entry tasks.
- Streamlined the registration process for patients, resulting in reduced wait times and increased satisfaction.
Education
Bachelor of Arts - Psychology
Southern New Hampshire University
New Hampshire05-2028
High School Diploma -
Grandview Senior High School
Grandview, Missouri05.2002
Skills
- Skilled communicator in varied environments
- Detail-oriented accuracy
- Proficient in medical terminology
- Adept at managing data systems
- Customer service focus on satisfaction
- Independent work proficiency
- Experienced with credentialing databases
- Knowledgeable about credentialing and privileging standards
- Cerner EHR proficiency
- Epic EHR proficiency
- Proficient in Adobe software
- Proficient in Microsoft Suite
- Salesforce proficiency
- Certify OS proficiency
- Cactus proficiency
- Teams proficiency
Timeline
Credentialer
Lucet
08.2023 - Current
Referral Specialist
Apex Systems
01.2022 - 06.2022
Provider Relations Specialist
Lucet
09.2021 - 08.2023
PRE REGISTRATION SPECIALIST
Saint Lukes Health System
11.2011 - 06.2020
Bachelor of Arts - Psychology
Southern New Hampshire University
High School Diploma -
Grandview Senior High School
Similar Profiles
Bernard James DiCasimirroBernard James DiCasimirro
Senior Vice President and Chief Medical Officer at LucetSenior Vice President and Chief Medical Officer at Lucet
Robin MendellRobin Mendell
Customer Service Associate at LucetCustomer Service Associate at Lucet
Angela WisdomAngela Wisdom
Case Manager Specialist at LucetCase Manager Specialist at Lucet
Amy GenzAmy Genz
Charge Registered Nurse at Advanced Correctional Healthcare Inc.Charge Registered Nurse at Advanced Correctional Healthcare Inc.
Tory GreenwellTory Greenwell
Lifegaurd at Belton High SchoolLifegaurd at Belton High School