Kelly Canham

• Collaborated with healthcare providers to gather necessary information for accurate credentialing decisions.
• Managed multiple priorities effectively, resulting in the on-time completion of credentialing tasks for numerous providers simultaneously.
• Conducted audits of provider files, ensuring all necessary documents were up-to-date and compliant with regulatory requirements.
• Enrolled providers and Medicaid, Medicare, and private insurance plans.
• Conducted primary source verifications such as background checks and board certifications.
• Prepared records for site visits and file audits.

FTCA Credentialing - Initial & Re-Credentialing. This includes communicating with new providers & gathering the appropriate documentation & verifying all information to send to the Credentialing Review Committee meetings for approval.

Enter providers in CredentialStream software and upload documents into system.

Audit credentialing files.

Medicare facility applications

All Dental Credentialing including facility credentialing.

Insurance Credentialing - FL Medicaid, Medicare, Aetna commericial, Aetna Better Health, Cigna, Healthfirst, & MMA plans.

AHCA Background Screenings & Fingerprinting for all providers & administrative staff.

Training of new credentialing specialists.

Delegated Credentialing

Primary source verifications including: NPDB, OIG, Sam.gov, Medicare Opt Out, social security death master file, preclusion list, Open payments, AMA & AOA profiles, etc...

Also did dental billing.

• Verified insurance of patients to determine eligibility.
• Communicated with insurance providers to resolve denied claims and resubmitted.
• Managed appeals process for denied claims, resulting in successful reimbursements from insurance companies.
• Filed and updated patient information and medical records.
• Implemented quality control measures to identify potential errors before submitting claims, reducing rejections significantly.
• Created CMN's to have equipment covered.

• Reviewed billing problems, researched issues, and resolved concerns.
• Managed monthly billing process to complete billings and returns to meet company revenue recognition policies.
• Trained and mentored staff on procedures, compliance requirements, and collections techniques.
• Managed collections with third party company.
• Conducted performance reviews and implemented improvement plans.
• Worked with customers to develop payment plans and bring accounts current.

• Input financial data and produced reports.
• Supported month-end closing process by preparing journal entries, account reconciliations, and variance analysis reports.
• Increased efficiency in accounts payable and receivable management, reducing processing time and minimizing errors.
• Billed insurances for durable medical equipment.
• Customer service
• Phone calls to insurances and patients.
• CMN's
• Worked EOB's and ATB reports.

• Maintained high coding standards by adhering to industry best practices and staying current with emerging technologies.
• Resourcefully used various coding books, procedure manuals, and on-line encoders.
• Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
• Reviewed patient charts to better understand health histories, diagnoses, and treatments.
• ICD-9 & CPT codes