Summary
Overview
Work History
Education
Skills
LANGUAGES
Timeline
Generic

Alesandra Hernandez

Tampa

Summary

Credentialing professional with solid foundation in healthcare administration. Known for driving efficiency in credentialing workflows and maintaining high standards of accuracy. Collaborative team member committed to achieving results and adapting to changing requirements. Skilled in data analysis and process improvement.

Overview

8
8
years of professional experience

Work History

Provider Credentialing Consultant

ATS Healthcare
01.2024 - 04.2025
  • Improved efficiency in the verification process through the creation and implementation of standardized templates for primary source verifications.
  • Played an instrumental role in preparing organizations for accreditation surveys, ensuring that all credentialing requirements were met ahead of time.
  • Maintained confidentiality by adhering strictly to HIPAA guidelines during the handling of sensitive provider information.
  • Kept abreast of changes in regulations, policies, and best practices within the field, applying this knowledge strategically when reviewing applications from healthcare professionals.
  • Provided excellent customer service to providers, addressing inquiries and concerns promptly while maintaining professionalism at all times.
  • Coordinated effectively with various departments to gather required documentation for provider applications, resulting in a more efficient and seamless credentialing process.
  • Conducted thorough audits of credential files to identify gaps or inconsistencies, leading to an overall increase in accuracy and reliability of provider data.
  • Enhanced compliance with industry standards through meticulous assessment of provider qualifications and credentials.
  • Assisted in resolving billing discrepancies by verifying provider information and updating necessary databases.
  • Educated providers on the importance of maintaining up-to-date credentials, leading to higher levels of compliance in the organization.
  • Managed multiple projects simultaneously, prioritizing tasks effectively to meet strict deadlines within a fast-paced environment.

Benefit Verification Specialist

Tek Systems (Amgen)
09.2023 - 01.2024
  • Ensure accurate patient health care benefits and coverage for necessary medical procedures.
  • Verify insurance information and resolve billing issues to maintain efficient processes.
  • Provide exceptional customer service to insurance payers, addressing inquiries and concerns.
  • Handle payer requests promptly, ensuring timely resolution and maintaining effective communication with insurance providers.
  • Prioritize and manage high-priority cases, ensuring prompt resolution.
  • Lead team goal-setting initiatives, maintaining motivation and focus.
  • Guide the team in time management and productivity techniques, consistently exceeding expectations.
  • Edit with the Docs app metrics.
  • Make tweaks, leave comments, and share with others to edit at the same time.

Case Manager

Sunshine Health
09.2021 - 03.2023
  • Coordinated care plans based on individual patient needs, insurance guidelines, and medical procedures.
  • Scheduling Medical Appointments
  • Maintained detailed documentation of patient progress and services provided.
  • Managed a diverse caseload, ensuring that each patient's needs were addressed appropriately.
  • Secured prior authorizations from insurance carriers for various levels of care.

Medical Claims Processor

Anthem/Eleavance
04.2020 - 09.2021
  • Reviewed insurance policies to determine claim approvals and denials based on coverage levels.
  • Investigated and corrected errors or omissions by interviewing agents and claimants.
  • Identified coverage limitations by thoroughly examining claims documentation.
  • Reviewed provider coding information to ensure accuracy and compliance with insurance policies.
  • Generated detailed reports on medical claims processing activities.

Provider Relations Representative (Contract)

Concentrix
01.2020 - 04.2020
  • Managed provider credentialing and recredentialing, including follow-up and application tracking.

Care Coordinator

Maximus Federal Services
01.2017 - 04.2019
  • Acted as liaison between patients, physicians, hospitals, and other care providers.
  • Assisted patients with insurance, billing inquiries, and logistics throughout their care journey.
  • Identified special assessment needs for complex cases and developed tailored care plans.
  • Follow up with patients to ensure satisfaction and resolve issues effectively.

Education

High School Diploma -

Thomas Jefferson High School
Tampa, FL
12.2019

Skills

  • Compliance
  • High-Volume
  • Case Manager
  • Insurance Verification
  • Inbound/Outbound Calling
  • Patient Eligibility & Benefits
  • Claims Reviewing & Settlements
  • Prior Authorization
  • Case Management
  • Provider Relations
  • Claims Processing &
  • EMR Systems & HIPAA
  • CPT Coding & Insurance Claim
  • Forms
  • Documentation
  • Billing & Payment Discrepancies
  • Explanation
  • Provider enrollment
  • Regulatory research
  • Audit preparation
  • Healthcare regulations
  • Compliance monitoring
  • Information management
  • Accreditation standards
  • Medical staff services
  • Credential verification
  • Recredentialing processes
  • Credentialing expertise
  • Credentialing software proficiency
  • Insurance procedures
  • HIPAA compliance
  • Document review
  • Provider relations
  • Data management
  • Proofreading
  • Application management
  • Credentialing oversight
  • Facility credentialing
  • Teamwork and collaboration
  • Problem-solving
  • Time management
  • Attention to detail
  • Problem-solving abilities
  • Multitasking
  • Organizational skills

LANGUAGES

Spanish
English

Timeline

Provider Credentialing Consultant

ATS Healthcare
01.2024 - 04.2025

Benefit Verification Specialist

Tek Systems (Amgen)
09.2023 - 01.2024

Case Manager

Sunshine Health
09.2021 - 03.2023

Medical Claims Processor

Anthem/Eleavance
04.2020 - 09.2021

Provider Relations Representative (Contract)

Concentrix
01.2020 - 04.2020

Care Coordinator

Maximus Federal Services
01.2017 - 04.2019

High School Diploma -

Thomas Jefferson High School

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