Resume 2

Amber Bush
1511 Jameson Dr. Objective

Virginia Beach, VA 23464
484-788-9629
To obtain a position as a healthcare professional, utilizing and building upon my
[email protected] exceptional leadership skills, abilities, and healthcare knowledge, advancing the
productivity, efficiency, and success of the company, while continuing to grow in
my career.
Qualifications
● Innovative leader, striving for the betterment of healthcare teams
● Knowledgeable in the development and delivery of training materials for
new hires
● Proficiency in verbal and written communication skills
● Attention to detail, professional, positive demeanor, high level of
organization
● Exceptional, superb time management and customer service capabilities
● Intense critical thinking skills with the ability to multi-task
● Computer knowledge: Microsoft Office, SharePoint, CACTUS, Facets,
Macess, Adobe Pro, Quantim, Electronic Health Records, Verscend Rapid
Retrieval, Member Medical History Plus (MMHP), Virginia Immunization
Information System (VIIS), Portal Accounts, Internet, typing speed 75+wpm
Education
ASMBC: Associate of Science in Medical Billing and Coding
Colorado Technical University, Colorado Springs, CO December 2012
● 3.8 GPA
Relevant Course Work: ICD-9-CM; CPT Coding/Billing; Advanced Coding;
Electronic Health Records: I and II; Pathophysiology with Pharmacology: I
and II; Healthcare Legal Concepts; Healthcare Management; Anatomy and
Physiology: I and II; Medical Terminology
Work Experience
Work Gap Jan 2023-present
● Homemaker/Disability
Due to LONG COVID, I needed to take an extended leave from work to
focus on my health and recovery.
CareSource Jan 2020-Jan 2023

● Health Plan Data Analyst III-Credentialing
Analyzed department processes advising on areas of needed
improvement, providing resolutions, and implementing changes
successfully for the betterment of the department; Provided data reports
on a daily, weekly, monthly, quarterly, semi-annually, and annually;
Presented reports as needed; Tested new programs/processes prior to
implementation to ensure accuracy and proper function; Managed all
escalated requests or state complaints, including credentialing,
contracting, provider data, and claims concerns while ensuring completed
resolutions; Prepared and presented all NCQA and state audits;
Researched state law requirements for Medicaid, Medicare, and
Marketplace credentialing and contracting standards; Updated systems
with new information when additional integrations were needed;
Assessed and audited department and CVO files for accuracy and quality
purposes, providing guidance for all improvements necessary; Assisted
department coordinators with processing of provider files as needed.
Anthem, Inc. March 2018-Jan 2020
● Amerigroup Credentialing Specialist Sr.
Knowledgeable in all department policies and procedures including
commercial and government lines of business; Responsible for auditing
the work of other credentialing specialists; Researched escalated audit
rebuttals and provided findings documentation to management; Assisted
with state and NCQA audits; Compiled and analyzed documents required
for credentialing committee; Responded to the most intricate provider
credentialing, compliance, and accreditation issues; Researched pended
applications and resolved discrepancies; Monitored reports identifying
practitioners on sanctions or those who do not meet credentialing criteria
for further action and assisted researching related issues; Identified and
carried out on-going training needs; Developed training materials and
updated all practitioner resources and job aides; Reviewed inventory
needs and assigned work accordingly; Communicated department needs
to management and provided process improvement suggestions and
solutions; Researched, analyzed, and resolved discrepancies between
credentialing programs and data reports; Provided feedback to
credentialing associates to assist in skill develop and to increase
knowledge; Connected with multiple state plans to ensure a unified
process was carried out seamlessly.
Anthem, Inc. Oct 2014-March 2018

● Amerigroup Credentialing Specialist
Hired as a permanent associate to continue credentialing for Amerigroup.
Continued all responsibilities listed under Kelly Services in addition to
training new associates on the initial credentialing process; Assisted with
creation and maintenance of the initial credentialing training manual;
Aided in identifying key changes in the integration process with Anthem;
Communicated with multiple state health plans as needed to clarify
policies and procedures; Provided training to new Health Plans on the
corporate initial credentialing process; Expedited, assigned, and
prioritized initial provider files as necessary; Responsible for contacting
state licensure boards regarding education verification upon licensure
and obtain letters with licensing requirements; Utilized Excel to create
charts which provided status updates on specific files for NJ, NV, and TN.
Helped plan and coordinate team building activities with our Team Morale
Committee.
Kelly Services
● Amerigroup Credentialing Specialist May 2014-Oct 2014
Responsible for conducting initial primary source verification (PSV)
process on medical providers applications to participate within the
Amerigroup network within state and department service level
agreements and contractual requirements; Communicate professionally
with providers and office staff, hospitals, and other institutions regarding
proper application completion and verification; Navigate, utilize, and
update Facets and Macess databases; Validate and update provider
information within CACTUS; Requires an extensive level of knowledge,
compliance and adherence to federal and state regulations for
credentialing
● WellPoint HEDIS Associate Jan 2014-May 2014
-Provided administrative and telephonic support for annual project and
the data collection process within a fast paced environment in order to
meet specific, time-sensitive deadlines; Contacted and corresponded with
medical providers and their practices; Requested medical record
information; Selected to assist multiple states with their retrieval process
as well; Utilized Member Medical History Plus (MMHP), Verscend Rapid
Retrieval, and other company claim systems to verify and locate member
information; Required understanding of Medical terminology knowledge
and use; Maintained a high level of professionalism at all times while
strictly adhering to all HIPAA regulations
La Petite Academy Sept 2013-Dec 2013

● Teacher (Part-time)
-Taught and supervised children age infant through 12 years;
Implemented play based curriculum; Communicated directly and
effectively with parents and children; Followed all licensing guidelines
and implemented company standards when providing daily care to every
child; Maintained a fun and interactive classroom that is clean and
organized
Man Power
● Order Puller for Gambles Distributors, Inc. May 2011-July
2012
-Implemented high levels of organization and reading comprehension to
efficiently fulfill customer orders; Accurately located and pulled parts for
order and prepared them for shipping; Assisted with packing pulled
orders for shipping; Conducted annual inventory of all parts within
warehouse
● Bookstore Clerk for Wildroot Bookstore Nov 2009-Feb

2011
-Responsible for opening/closing the bookstore; Maintained a clean and
organized environment at all times; Assisted customers and answered
any questions they may have had; Placed weekly book orders; Received
merchandise orders, checked for accuracy, entered into POS system,
and stocked inventory; Cash handling; Implemented new POS system
and accurately entered all inventory within the store
Stream, Inc. August 2005-March 2006

● Customer Service Professional
-Provided customer service at a professional level in a fast paced, high
volume, inbound call center; Activated new accounts; Verified customer
information; Effectively provided product support and services;
Processed Billing inquiries; Transferred calls to proper departments
when necessary
References available upon request.

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Amber Bush

1511 Jameson Dr. Objective

CareSource Jan 2020-Jan 2023

Anthem, Inc. Oct 2014-March 2018

La Petite Academy Sept 2013-Dec 2013

● Bookstore Clerk for Wildroot Bookstore Nov 2009-Feb

Stream, Inc. August 2005-March 2006

References available upon request.

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