- Languages: Spanish (Native), English (B2 - Upper Intermediate).
Job Search Status
Open to workDesired start date: Flexible
Open To Work
Carmen Janice Gonzalez Perez
Tampa,FL
Work Preference
Summary
Facilitated provider credentialing, contract auditing, and ensured comprehensive regulatory compliance across all U.S. states and territories to support healthcare operations.
Overview
11
11
years of professional experience
Work History
Team Leader / Contract Setup Analyst
Delta Dental Providers USA
02.2022 - Current
- Team Leadership: Supervise and guide the contract setup team, ensuring accuracy in document processing and strict adherence to departmental KPIs.
- National Regulatory Compliance: Oversee and audit provider contracts for all 50 U.S. states and territories, ensuring 100% alignment with diverse state laws and federal regulations.
- Contract Life Cycle Management: Manage the end-to-end process for new and existing provider contracts, including credentialing, rate validation, and IRS document auditing (W-9/SS-4).
- Stakeholder Management: Provide high-level support to medical groups and providers regarding hiring status, credentialing updates, and demographic information.
- Operational Excellence: Direct the flow of requests to specialized departments and manage the distribution of welcome letters and official notifications.
Medicaid Provider Representative
Medicaid Government Health Plan
10.2020 - 11.2021
- Facilitated provider enrollment on the Medicaid PEP platform.
- Managed LMS and PSC systems to secure Medicaid IDs for individual practitioners, groups, and facilities, enabling successful claims for professional 1500 and UB04 forms.
Providers USA Representative
MMM
07.2018 - 10.2020
- Analyzed claims, financial recoveries, and adjustments following ICD-10, CPT, and CMS guidelines.
- Utilized specialized healthcare platforms including QNXT, Innova MD, and Inmediata.
Providers and Customers Services
Molina Health Care PR
12.2014 - 07.2018
- Responsible for eligibility verification, medical authorizations, and auditing 1500 and UB04 claims.
- Managed pharmacy and procedure status via MC-21 and PAHUB platforms.
Education
Bachelor of Business Administration - Management
Universidad del Este (AGMU)
Associate Degree - Natural Sciences (Biology)
UAGM, Puerto Rico
Skills
Platforms: QNXT, Medicaid PEP, Innova MD, Inmediata, Secure Claims, Assertus, MC-21, PAHUB
Knowledge: Contract Law, CMS Guides, COB, CPT/ICD-10 Codes, IRS and DEA Validations
Languages
CUST
- Sugerencias adicionales:
- Formato: Al imprimirlo
- Guardarlo en PDF, asegúrate de que ocupe máximo 2 páginas.
- Palabras Clave: He incluido términos como "National Regulatory Compliance" y "Team Leadership" que son muy buscados por los reclutadores en Florida.
- ¿Te gustaría que te ayude con algo más, como una carta de presentación para una empresa específica en Tampa?
Timeline
Team Leader / Contract Setup Analyst
Delta Dental Providers USA
02.2022 - Current
Medicaid Provider Representative
Medicaid Government Health Plan
10.2020 - 11.2021
Providers USA Representative
MMM
07.2018 - 10.2020
Providers and Customers Services
Molina Health Care PR
12.2014 - 07.2018
Bachelor of Business Administration - Management
Universidad del Este (AGMU)
Associate Degree - Natural Sciences (Biology)
UAGM, Puerto Rico