Summary
Overview
Work History
Education
Skills
Timeline
Generic

TYRANNI MATHEWS

Atlanta

Summary

Enthusiastic and professional. Highly motivated, dependable, and goal-oriented individual. Able to work under pressure and collaborate with multiple teams. Committed to being a team player, as well as excelling individually with minimal supervision. Possesses dynamic leadership qualities that promotes positive work culture, effective team building, and overall company success.

Overview

4
4
years of professional experience

Work History

Arbitration Specialist

HaloMD
09.2023 - Current
  • Update funding, Policy, Plan type in Arbit using EOB codes, HCFA, Op reports or Verifiable insurance information
  • Use availity, waystar, GoRev and other insurance portals to verify patient insurance and benefits
  • Update claim to reflect if self/fully-funded , medicaid/medicare or Federal IDR / No Arbitration
  • Payment Posting/ Medical billing ; UB-04 & CMS 1500
  • Outbound calls to carriers if unable to verify coverage/funding type on portal
  • Completed member eligibility and coordination of benefits for clinicians or facilities

Provider Enrollment Specialist

EnableComp, LLC
11.2023 - 07.2025
  • Enrolls providers with all commercial health plans specific to the market.
  • Enrolls providers with both OOS Medicaid and Medicare.
  • Facilitates initial appointment, re-appointment and tracking of expired documents.
  • Reviews and performs primary source verification of all applicant licensure, education and training, relevant employment history, and affiliations; assesses risk exposure during and at the time of recredentialing.
  • Responsible for the accuracy and integrity of the credentialing database system and related applications.
  • Works with payors to ensure proper enrollment for billing and payment receipt.
  • Performs other related duties as assigned with Medicaid, Medicare, and other commercial payors.
  • Reviews data in provider record, specifically taxonomy and specialty, and ensures it is correct prior to submitting applications
  • Performs follow up with health plans 30 days after submission and then biweekly thereafter until the provider is PAR
  • Escalates known issues to manager for assistance.
  • Collaborates with credentialing team regularly to ensure that there is an awareness of all new providers who are onboarding
  • Other duties as assigned

Credentialing Specialist

MultiPlan
11.2021 - 10.2023
  • Communicated with providers primarily by phone verifying and correcting demographic information location and billing.
  • Researched and resolved a variety of providers demographic inquires at the point of service to ensure customer retention and satisfaction.
  • Communicated provider feedback for follow up when required to ensure satisfactory resolution.
  • Educated providers via phone to ensure inquiry resolution.
  • Ensured accurate information updates for input into all the companys applications.
  • Gathered provider credentialing documents necessary to complete enrollment requirements.
  • Compiled applications for submission to the practitioner.
  • Provided timely follow up with outstanding items from client and provider.
  • Performed credentialing maintenance for providers - credentialing, CAQH file updates.

Education

Associate - Cybersecurity / Web Development

Emory University
Atlanta, GA
07.2017

Skills

  • ICD-10
  • Office 365
  • EMR systems
  • Medical terminology
  • 65 WPM
  • EOB / HCFA / OP REPORT
  • EPIC
  • MEDICAL BILLING
  • Blue Prism Robotic Automation
  • HIPAA
  • Commercial (HMO, PPO)
  • Software Engineering
  • IT
  • 5 years Medical receptionist
  • OOS MEDICAID

Timeline

Provider Enrollment Specialist

EnableComp, LLC
11.2023 - 07.2025

Arbitration Specialist

HaloMD
09.2023 - Current

Credentialing Specialist

MultiPlan
11.2021 - 10.2023

Associate - Cybersecurity / Web Development

Emory University

Similar Profiles

CREATE PROFILE
TYRANNI MATHEWS