Terri Martinez
San Tan Valley,AZ
Overview
29
29
years of professional experience
1
1
Certification
Work History
Erollment Sprecialist
Acumen Fiscal Agent
05.2023 - Current
- Receives large number of calls (internal & external) regarding new and existing enrollment files.
- Places a large number of outbound follow-up calls to clients in order to update existing files or complete new enrollment
files. - Interacts daily with program stake holders via phone and/or electronically.
- Registers potential and existing customers using several data bases with high accuracy.
- Receives, researches, sorts, files, retrieves forms, correspondence and documents of confidential and time-sensitive
nature. Includes following up with state individuals and families for possible resolution/s.
- Manages, distributes and tracks program specific materials as needed and/or requested.
- Maintains a complex filing system.
- Works well independently with limited supervision. Analyzes and resolves all customer inquiries.
- Uses strategic thinking to complete multiple tasks.
- Conducts thorough and accurate research.
- Demonstrates a working knowledge of and abides by contract, state and Medicaid specifications.
- Identify and share opportunities for process improvements and improved working conditions.
- Willing to occasionally work other than typical work hours to meet high volume demands.
- Performs other work related activities as assigned.
- To be vigilant to support the positive compliant cybersecurity company posture by familiarizing
themselves with all policies, procedures, standards, and guidelines and act accordingly.
Credentialing Specialist
AB Staffing Solutions
02.2016 - 05.2018
- Managed multiple clients and projects to ensure medical and behavioral health providers maintain current credentials and licenses
- Led, coordinated, and monitored the review and analysis of practitioner applications and accompanying documents, ensuring participation status and applicant eligibility
- Conducted thorough background investigation, research and primary source verification of all components of the application file
- Identified issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up
- Processed requests for privileges, ensuring compliance with clinical privilege criteria
- Responded to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise
- Assisted with managed care delegated credentialing audits; conducts internal file audits
- Maintained, updated, and revalidated provider profiles in CAQH, PECOS, NPPES, and CMS
- Utilized credentialing software, Excel Spreadsheets, databases, and PDF documents to organize provider files
Utilization Coordinator Specialist
Preferred Homecare
11.2014 - 02.2016
- Connected with patients and health care providers to provide outcome-based solutions for physician referral sources and existing patient population
- Processed new orders, authorizations and referrals, assembled information concerning patient's clinical background and referral needs
- Prepared and analyzed the billing and setup paperwork for patient services
- Worked closely with existing patients to troubleshoot issues, identify solutions, and dispatch corrective action via the appropriate departments within the organization
- Provided operations and procedure training to customer service associates and sales personnel
Paralegal Assistant
Hastings and Hastings
03.2014 - 10.2014
- Assisted paralegals with client's files and case management tasks, following up on medical records and bills for clients' cases, and preparing medical chronologies
Fulfillment Coordinator
Longevity Alliance
03.2013 - 02.2014
- Collected and scanned invoices into the patient database, creating excel invoices for payment
- Provided auditing for correct payment amount and correct HCPC codes for billing
- Submitted spreadsheets to materials management for final approval
CSR/Customer Service Representative
Otto Bock Healthcare
11.2007 - 03.2013
- Tracked and monitored customer DME written orders through the Bright Tree database
- Verified patient insurance benefits determined co pays if any due at the time of service
- Audited claims; resolved and resubmitted for payment to variety of Insurance providers
- Supported team members with managing of overflow of customer calls and inquiries
- Created Certified Medical Necessity (CMN), faxed to providers for support of claim being paid
Accounts Payable Clerk
Mesa Christian Nursing Home
06.1995 - 12.1996
- Performed a large range of accounting and clerical tasks related to the accounts payable function and generally include receiving, processing, and verifying invoices, tracking, and recording purchase orders, and processing payments
- Received and managed invoices from vendors matching documents with the scheduling database to set up payment for services completed for the facility
Skills
- Credentialing Specialist
- Customer Service
- Billing
- Administrative Support
- Data Entry
- Database Management
- Research Skills
- Source Verification
- Time Management
- Licensing
- Accounts Payable
- Records Documentation/Management
- Patient Support
- MS Office
- Word
- Excel
- Outlook
- Brightree
- AS400
- Ultra Staff
- Lawson
- DocuSign
- Health Plan Websites
- CAQH
- Licensing Boards
- National Provider DB
- Hospital CVO's
Certification
Credentialing Specialist (CPCS), Certification in Progress
Timeline
Erollment Sprecialist
Acumen Fiscal Agent
05.2023 - Current
Credentialing Specialist
AB Staffing Solutions
02.2016 - 05.2018
Utilization Coordinator Specialist
Preferred Homecare
11.2014 - 02.2016
Paralegal Assistant
Hastings and Hastings
03.2014 - 10.2014
Fulfillment Coordinator
Longevity Alliance
03.2013 - 02.2014
CSR/Customer Service Representative
Otto Bock Healthcare
11.2007 - 03.2013
Accounts Payable Clerk
Mesa Christian Nursing Home
06.1995 - 12.1996
Credentialing Specialist (CPCS), Certification in Progress
Similar Profiles
Maycie YatesMaycie Yates
Personal Care Assistant at Acumen Fiscal AgentPersonal Care Assistant at Acumen Fiscal Agent
Zachary NealZachary Neal
Direct Care Worker at Acumen Fiscal AgentDirect Care Worker at Acumen Fiscal Agent
Sabrina DziadoszSabrina Dziadosz
Caregiver at Acumen Fiscal AgentCaregiver at Acumen Fiscal Agent
Tomaurie SmauldingTomaurie Smaulding
Enrollment Specalist at Acumen Fiscal AgentEnrollment Specalist at Acumen Fiscal Agent
Tania AmayaTania Amaya
Medical Chat Support Supervisor at Good Health MedicalMedical Chat Support Supervisor at Good Health Medical