Summary
Overview
Work History
Education
Skills
Timeline
Generic

Bounlom Sonthipanya

Summary

Accomplished Credentialing Specialist with over 10 years of experience accomplishing demanding information security related tasks. Maintains strict data accuracy, retention and access expectations according to internal productivity demands. Organized, thorough approach toward handling credentialing procedures and addressing requests-for-access's prefer a culture that allows me to prioritize multiple projects with minimal supervision, work proactively rather than reactively and develop relationships with colleagues for a stronger team.

Overview

19
19
years of professional experience

Work History

Credentialing Manager (Director in Training)

Clin-Path Associates, PLC
07.2022 - Current
  • Streamlined credentialing processes by implementing efficient tracking systems and reducing paperwork.
  • Managed the onboarding process for new providers, ensuring timely completion of all required documentation.
  • Collaborated with department leaders to develop policies and procedures for maintaining accurate provider records.
  • Ensured accuracy of provider data in internal databases through regular review and updates.
  • Developed comprehensive training materials for new hires, promoting consistency in credentialing processes across the organization.
  • Assisted with the preparation of reports for senior management, highlighting key achievements and areas for improvement within the department.
  • Maintained up-to-date knowledge of industry regulations, ensuring ongoing adherence to best practices in provider credentialing.
  • Implemented a secure document storage system that improved confidentiality while ensuring easy access during audits.
  • Demonstrated excellent problem-solving skills in identifying and resolving discrepancies in provider documentation, ensuring compliance with regulatory requirements.
  • Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
  • Evaluated employee performance and conveyed constructive feedback to improve skills.
  • Assisted in organizing and overseeing assignments to drive operational excellence.
  • Maintain physician CVs
  • Keep track of all PSA and CPA clients' CLIA certificates.
  • Apply for/Update NPPES, PECOS, and CAQH information. Revalidate pathologists CAQH information every 120 days, based on enrollment date
  • Complete credentialing updates for PSA and CPA Executive Meetings
  • Supervise/provide guidance/train Hospital Credentialing Coordinator

Credentialing Specialist

Foothills Sports Medicine/ Confluent Health
10.2021 - Current
  • Improved turnaround time for credentialing applications by implementing an efficient online system.
  • Manage AZ Medicare and AZ Medicaid portals
  • Ensured compliance with industry standards by regularly updating policies and procedures related to credentialing.
  • Collaborated with healthcare providers to gather necessary information for accurate credentialing decisions.
  • Complete provider/facility credentialing and re-credentialing applications with contracted insurance companies
    • Ensure all credentialing applications and forms are completed accurately, thoroughly and timely
    • Monitor the status of each provider's/facility's credentialing and re-credentialing
    • Research and correct any credentialing issues with insurance companies
    • Communicate status of provider/facility credentialing to applicable practices and Management.
    • Track provider license expirations to ensure timely renewals
    • Maintain knowledge of credentialing guidelines and network participation with insurance companies
    • Maintain professional liability insurance for all facilities
    • Complete the necessary paperwork for health plan site visits
    • Initiate and maintain CAQH files on all providers

Credentialing Representative

NextCare Urgent Care
02.2018 - 07.2021
  • Responsible for multiple Urgent Clinics and Physician Medicaid, Medicare
  • Payor enrollments within Colorado, Kansas, Missouri, Wyoming and Arizona
  • Collaborated with cross-functional teams to develop new strategies for increased revenue generation.
  • Developed comprehensive reports, enabling management to make informed decisions based on accurate data analysis.
  • Provided valuable input during team meetings, resulting in the identification of new opportunities for growth and development within the organization.
  • Spearheaded process improvement projects, leading to significant time savings without compromising quality or accuracy of work completed.
  • Managed and maintained credentials and confidential information for Urgent Care Clinics and Physicians within Colorado, Kansas, Missouri, Wyoming and Arizona
  • Professional communication with State Medicaid and Insurance offices to ensure applications received and correct
  • Managed and completed all necessary follow up to application corrections and document submission
  • Updated existing Procedure Handbooks for each represented,

Credentialing Representative/Front and Back Desk Receptionist

Ironwood Cancer And Research Center
01.2016 - 02.2018
  • Enhanced company reputation by providing exceptional customer service and support.
  • Started off in front office checking patients in for office visits and Chemo appointments
  • Evaluated customer needs and feedback to drive product and service improvements.
  • Developed and updated tracking spreadsheets for process monitoring and reporting.
  • Started working back office, scheduling chemo while supporting both front office and check out desk
  • Managed and maintained credentials and confidential information for Hospitals and Physicians
  • Professional communication with State Medicaid and Insurance offices to ensure applications received and correct
  • Managed and completed all necessary follow up to application corrections and document submission
  • Created single database for Physician credentialing from multiple spreadsheets
  • Assumed all Physician credentialing for Managed Care and Licensure
  • Able to provide excellent level of credentialing service
  • Ensure all Physician credentialing current and proactively renew licensure when necessary
  • Maintained database systems to track and analyze operational data.
  • Managed physicians schedules for Boards and Re-Certifications

Distribution Center Representative

Avnet Logistics
08.2005 - 08.2015
  • Utilized computer bar codes
  • Coordinated shipping and receiving customer orders without
  • Increased customer satisfaction by addressing and resolving complaints in a timely manner.
  • Streamlined internal processes for improved efficiency, reducing overall costs for the organization.
  • Double checking for discrepancies Maintaining 100% quality
  • Exceeded performance targets through diligent work ethic and focus on results-driven tasks.
  • Developed comprehensive reports, enabling management to make informed decisions based on accurate data analysis.

Education

No Degree - Business

Chandler Gilbert Community College
Gilbert, AZ

MMA Certification - Medical Administration

Pima Medical Institute
Mesa, AZ
01.2016

Skills

  • Strong organizational and
    Interpersonal skills dealing with a
    Diverse range of people and
    Personalities
    ▪ Ability To apply common sense
    Understanding To solve practical
    Problems and deal with a variety of
    Situations
    ▪ Ability To act with integrity in regard
    To all matters of confidentiality
    ▪ Basic knowledge of medical
    Terminology
    ▪ Excellent customer service skills
    ▪ Self-motivated and attention to detail
    ▪ Capacity to work under pressure

Timeline

Credentialing Manager (Director in Training)

Clin-Path Associates, PLC
07.2022 - Current

Credentialing Specialist

Foothills Sports Medicine/ Confluent Health
10.2021 - Current

Credentialing Representative

NextCare Urgent Care
02.2018 - 07.2021

Credentialing Representative/Front and Back Desk Receptionist

Ironwood Cancer And Research Center
01.2016 - 02.2018

Distribution Center Representative

Avnet Logistics
08.2005 - 08.2015

No Degree - Business

Chandler Gilbert Community College

MMA Certification - Medical Administration

Pima Medical Institute

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