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Kelly Borom

Romulus, MI

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Work Experience

Credentialing Coordinator

Hap Midwest Health Plan
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Dearborn, MI
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June 2014 to Present

Responsibilities 
inates, and monitors the review and analysis applications and accompanying documents, ensuring applicant eligibility. Conducts thorough background investigation, research and primary source verification of all components of the application file. Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up. Prepares credentials file for completion and presentation to Health System Entity Medical Staff Committees, ensuring file completion within time periods specified. Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions. Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day today credentialing and privileging issues as they arise. Assists with managed care delegated credentialing audits; conducts internal file audits. Utilizes the Cactus and CAQH credentialing database, optimizing efficiency, and performs query, report and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act. Monitors the initial, reappointment and expiable process for all medical staff, Allied Health Professional staff, Other Health Professional staff, and delegated providers, ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state), as well as Medical Staff Bylaws, Rules and Regulations, policies and procedures, and delegated contracts. Performs miscellaneous job-related duties as assigned.

Health Unit Coordinator

Sparrow Hospital
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Lansing, MI
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August 2012 to January 2014

  
 
Entry of physician orders, such as laboratory requests, into the system in accordance with hospital policies and procedures. Entry of patient charge into the computer system using the ICD coding for correct insurance billing, analyze and process orders, Maintain departmental records, files, correspondence, reports schedules, inbound / outbound calls, epic system Deliver or obtain items from other departments as needed. Clean and maintain job- related equipment, supplies, and environment Maintaining hospital standards by participating in in-services, committees, responsible for presenting new associates as assigned by department manager, as I work independently in stressful situations and prioritize work, manage multiple immediate / emergent demands, tabulate and post departmental data log sheets, receive payments from, patients, make receipts, balance out accurately and follow established procedures for billing.

MEH Representative

Accretive Health
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Detroit, MI
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May 2012 to August 2013

                          
Accretive health Medicaid eligibility hub, clinical documentation Improvement Specialist for the overall responsibility for facilitating documentation of the medical record to achieve accurate inpatient coding and DRG assignment with our client executives and maintain client support.

TCATTE Grant Secretary

Eastern Michigan University
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Ypsilanti, MI
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February 2011 to July 2011

Reconcile P-card purchases with grant account, process honorariums, workshop stipends, travel reimbursements, purchase of supplies, prepare documents for workshops, submit paperwork for SB-CEU's and completes the sponsor verification form, create and maintain the calendar for scheduled observations.

Health Unit Coordinator

Detroit Hope Hospital
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Detroit, MI
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February 2008 to March 2009

Notifies RN's of admission, tranfers and discharges, completes paperwork for inter / intra unit transfer. Transcribes orders and organizes mail while receiving inbound and outbound calls, verifies diet information and enter diet changes into computer.

Medical Records Clerk 2

St. John Riverview Hospital
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Detroit, MI
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April 1999 to July 2007

  
 
Creates new medical records and retrieves existing medical records by gathering appropriate record folders and contents; assigning and recording new record numbers; verifying existing record numbers; inputting and recording locations to computer; delivering records. 
 
Accepted responsibilities include filling, reception, dictation, alpha / numeric data entry, transcription, identified case flips, assemble charts, analyzes electronic medical record, update patients management system, t-d-5, charting, and i-cd-9 Coding.

MEH Representative

Accretive Health
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Detroit, MI
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May 2012

  
 
Responsible for the performance of all pre-registration functions contacting patients directly and/or using other means to secure a set of critical data elements needed to asses and secure financial risks to the organization. Performance of low risk insurance verification functions, using various resources to verify basic patient insurance eligibility. Responsible for incoming and outgoing calls to patients regarding the above. Performed clinical documentation improvement specialist for the overall responsibility for facilitating documentation of the medical record to achieve accurate inpatient coding and DRG assignment with our client executives and maintain client support.

Education

Associate of Science in Criminal Justice

Itt Technical Institute -
Dearborn, MI

2010 to 2011

Business

Detroit Entrepreneur Institute -
Detroit, MI

January 2008 to January 2009