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
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