KIMBERLY BAILO
Columbus
Summary
Experienced credentialing coordinator with a strong background in medical provider enrollment and compliance, as well as healthcare operations. Demonstrated expertise in credentialing, billing, and enrollment processes to ensure accuracy and adherence to regulations. Proven ability to identify and resolve credentialing issues, while effectively managing multi-market credentialing, supervising agreements, and streamlining workflows for optimal efficiency.
Overview
41
41
years of professional experience
Work History
Credentialing Coordinator
Wellstreet Urgent Care
08.2021 - Current
- Manage end-to-end provider credentialing across multiple markets, ensuring compliance with state and federal regulations
- Conduct PSVs, document verification, and analyze credentials for accuracy and completeness
- Identify and resolve discrepancies, time gaps, and compliance issues that impact enrollment
- Monitor license and credential expiration dates, ensuring timely renewals
- Develop and refine internal credentialing processes, conducting policy research and updates
- Track supervising agreements and ensure timely submission for approval
- Optimize workflows with automation and alerts using Smartsheet and LOOP
Enrollment/Credentialing Specialist
PBCP Services LLC
10.2019 - 08.2021
- Credential & enroll for 7 separate FOHC's and the providers
- All specialties including Dental and Behavioral Health
- In and out of state enrollments
- Managed in-state and out-of-state enrollments for multiple healthcare organizations
- Processed onboarding, enrollment updates, and credentialing verifications
- Maintained provider credentials and tracked payer workflow
Financial Care Agent
Piedmont Columbus Regional
04.2018 - 10.2019
- Screen applicants to provide accurate estimates for financial assessments for possible payment of services
- Calculate, offer, and negotiate payment arrangements per guidelines
- Complete income-based charity application for medical services
- Receive & process payment and documents in the account
Credentialing Specialist II
Vantage Oncology
05.2014 - 12.2016
- Managed provider enrollment and credentialing for multiple payer contracts
- Conducted regulatory license verification and maintained credentialing databases
- Trained staff on credentialing software and best practices
Accounts Receivable Specialist
Tri-State Orthopedics
07.2003 - 05.2014
- Efficient operation and effective reimbursement of third-party account receivables
- Researched and reconciled accounts
- Corrected physician coding
- Tracked physician charge patterns by procedure, diagnosis, and denials for better performance and processing
Manager of Accounts Receivable
Fox Rehabilitation Services
01.2007 - 01.2009
- Responsible for hiring, training, and evaluation of employees
- Responsible for the performance and priorities of the department including the month-end activities
- Enrolled Physical and Occupational Therapists with Medicare and Medicaid
- In and out of state enrollment
- Reduce outstanding AR and set up workflow processes for the collection and billing personnel
- Ensure deposits and adjustments are posted and reconciled daily
Accounts Receivable/Surgery Scheduler/Medical Assistant
Kitsap Orthopedics
01.1999 - 01.2003
Accounts Receivable/Insurance Representative
Midlands Orthopedics
01.1995 - 01.1998
Psychiatric Technician
Army Medical Centers
01.1984 - 01.1991
Education
Associate of Science (AS) -
Camden Community College
01.2012
Bachelor of Science (BS) -
University of Southern Indiana
03.2025
Skills
- Medical Provider Credentialing & Enrollment
- Primary Source Verifications (PSVs)
- Supervising Agreements Management
- Regulatory Compliance & Policy Research
- CAQH
- Billing & Insurance Enrollment
- Database & Remote Work Proficiency
- Microsoft Excel
- Microsoft Word
- Smartsheet
- LOOP
- Collaboration with JV Partners
Hobbies and Interests
- Hiking
- Running
- Bicycling
- Photography
- Volunteering
Timeline
Credentialing Coordinator
Wellstreet Urgent Care
08.2021 - Current
Enrollment/Credentialing Specialist
PBCP Services LLC
10.2019 - 08.2021
Financial Care Agent
Piedmont Columbus Regional
04.2018 - 10.2019
Credentialing Specialist II
Vantage Oncology
05.2014 - 12.2016
Manager of Accounts Receivable
Fox Rehabilitation Services
01.2007 - 01.2009
Accounts Receivable Specialist
Tri-State Orthopedics
07.2003 - 05.2014
Accounts Receivable/Surgery Scheduler/Medical Assistant
Kitsap Orthopedics
01.1999 - 01.2003
Accounts Receivable/Insurance Representative
Midlands Orthopedics
01.1995 - 01.1998
Psychiatric Technician
Army Medical Centers
01.1984 - 01.1991
Bachelor of Science (BS) -
University of Southern Indiana
Associate of Science (AS) -
Camden Community College
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