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Operations Resolution Specialist at MediGold
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Competencies
Proficient in high-volume data processing, validation, discrepancy tracking, and quality assurance.
Experienced in ensuring regulatory adherence through accurate records, credentialing, and audit preparation.
Skilled in structured records management, SOP development, and workflow documentation for operational efficiency.
Supports complex workflows, operational reporting, and multi-system data maintenance.
Education
Summary
Dedicated professional with extensive experience in healthcare data management, credentialing, and operational workflows. Skilled in ensuring regulatory compliance, data integrity, and process optimization across healthcare and corporate environments.
Key Achievements
- Ensured regulatory compliance and maintained audit-ready provider records across multi-state datasets.
- Supported operational workflows and data management for Medicare Advantage plans, improving accuracy and efficiency.
- Performed primary source verification and credentialing, ensuring adherence to CMS and payer standards.
- Maintained high standards of data integrity and quality assurance in diverse healthcare and corporate systems.
Experience
Operations Resolution Specialist - Provider Data Management (Operational Workflow Support)
Served as subject-matter resource for Provider Data Management operations, supporting regulatory compliance and accurate provider records across multi-state datasets.. Maintained audit-ready provider data including demographics, licensure, affiliations, NPIs, taxonomy, and contract-related elements within multiple enterprise systems.. Reviewed automated error reports, corrected failed uploads, validated updates, and confirmed clean-file outcomes to support claims processing, directories, and downstream reporting.. Coordinated monthly roster submissions using Excel, identifying discrepancies, documenting issues, and ensuring clean outputs for operational teams.. Partnered cross-functionally with Contracting, Credentialing, IT, Network Operations, and Provider Services to maintain data accuracy and operational readiness.. Investigated and resolved complex data issues by tracing discrepancies to source systems and maintaining clear documentation for audits and future reference.. Supported delegated provider onboarding workflows, contributing to standardized procedures that improved intake consistency and reduced downstream errors.. Authored and maintained SOPs covering roster processing, discrepancy resolution, and audit documentation practices.. Assisted with HEDIS and audit preparation by validating workflows, organizing documentation, and supporting corrective action follow-through.. Acted as an escalation resource for operational issues, reviewing analyst work during training or remediation efforts to reinforce data quality standards.. Processed and validated high-volume provider and facility records with strong accuracy and turnaround expectations.. Maintained large-scale provider master data records across enterprise healthcare systems, ensuring data accuracy, completeness, and consistency across operational and reporting environments.
Credentialing Coordinator & Data Management Specialist
Performed primary source verification and credentialing review for providers and facilities, ensuring compliance with CMS, payer, and regulatory standards.. Maintained accurate credentialing records including licensure, board certification, malpractice history, education, and professional documentation.. Reviewed applications for completeness and accuracy prior to submission, identifying discrepancies and coordinating follow-up to resolve gaps.. Supported audit readiness by organizing documentation, tracking verification status, and maintaining defensible credentialing files.. Partnered with Provider Data Management, Network Operations, and Compliance teams to ensure credentialed providers were operationally ready for system loading and downstream processes.. Monitored expirables and renewal timelines, initiating outreach and documentation updates to maintain uninterrupted provider participation.. Assisted with onboarding workflows by coordinating credentialing steps alongside contracting and operational teams.. Maintained detailed tracking logs and status updates to support reporting, internal reviews, and leadership visibility.. Applied strong attention to detail when reviewing high-volume credentialing files while meeting established turnaround expectations.
Patient Coordinator & Billing Specialist
Maintained accurate patient demographic, scheduling, and billing data across multiple practice systems.. Generated invoices, posted payments, and resolved billing discrepancies with attention to detail.. Verified timecards and supported claims submission and tracking.. Produced administrative reports and ensured financial record accuracy.. Managed confidential patient and financial information in compliance with privacy requirements.
Bibliographer
Entered, validated, and maintained structured records and catalog data, supporting database accuracy and content updates.. Researched and documented materials to support database and website updates.. Supported documentation accuracy, content updates, and administrative operations.
Product Engineering Technician
Entered, updated, and maintained Bill of Materials (BOM) data within enterprise systems, ensuring accuracy, consistency, and version control across multiple product lines.. Processed engineering change requests, assigned product and component codes, and validated updates to maintain data integrity throughout the production lifecycle.. Converted handwritten BOM documentation into structured Excel spreadsheets, improving data accessibility, usability, and cross-team reference.. Coordinated sample orders and shipment tracking, maintaining organized documentation to support engineering reviews and product launches.. Supported engineers and executive leadership with administrative, scheduling, and documentation tasks, ensuring timely communication and operational continuity.. Maintained detailed records and supporting documentation to enable efficient collaboration between engineering, operations, and leadership teams.
Licensing Commission Representative
Maintained and updated state licensing records for insurance agents and general agents across all 50 states, ensuring accuracy and regulatory compliance.. Built and maintained commission hierarchies for agents and general agents, supporting accurate downstream commission processing and reporting.. Assisted the Commission Accounting department by researching and reconciling data discrepancies impacting commission payments.. Performed data integrity reviews and validation to confirm licensing status, hierarchy alignment, and completeness of agent records.. Coordinated directly with state insurance regulation offices to obtain, verify, and document licensing information and required regulatory materials.. Supported standardized workflows and documentation practices to ensure consistent handling of licensing and commission data.. Provided administrative and operational support for large, multi-state datasets in a regulated environment requiring accuracy and confidentiality.