Carol Olvera Pinon
Forest Grove
Summary
Dynamic Credentialing Team Lead at Virginia Garcia Memorial Health Center with expertise in regulatory compliance and process improvement. Proven track record in mentoring teams and enhancing workflow efficiency. Skilled in primary source verification and effective communication, ensuring high-quality service standards and successful healthcare provider enrollments.
Overview
9
9
years of professional experience
Work History
Credentialing Team Lead
Virginia Garcia Memorial Health Center
Hillsboro
03.2023 - Current
- Led team meetings to discuss patient care and workflow improvements.
- Mentored new employees on best practices and organizational policies.
- Monitored team performance to maintain high-quality service standards.
- Managed credentialing processes for healthcare providers and facilities.
- Reviewed applications for accuracy and compliance with regulatory standards.
- Coordinated with medical staff to gather required documentation and references.
- Implemented process improvements to streamline the credentialing workflow.
- Performed primary source verifications such as criminal histories, licenses and board certifications.
- Checked applications for missing information and organized all paperwork.
- Maintained detailed records of provider data in the credentialing database system.
- Participated actively in special projects or initiatives pertaining to improvement of operational efficiency within the department.
- Completed enrollments into Medicaid, Medicare and private insurance plans.
- Coordinated with internal departments such as medical staff services or risk management to resolve any issues identified during the verification process.
- Attended meetings and seminars related to healthcare industry regulations and trends.
- Interacted regularly with representatives from health plans and commercial payers regarding credentialing matters.
Credentialing Specialist
Virginia Garcia Memorial Health Center
Hillsboro
09.2022 - 03.2023
- Managed credentialing processes for healthcare providers and facilities.
- Reviewed applications for accuracy and compliance with regulatory standards.
- Coordinated with medical staff to gather required documentation and references.
- Maintained accurate databases of credentialing records and updates.
- Assisted in training new staff on credentialing policies and procedures.
- Collaborated with insurance companies to verify provider credentials efficiently.
- Implemented process improvements to streamline the credentialing workflow.
- Ensured timely completion of credentialing processes by providing guidance to providers on required documentation.
- Reviewed and processed credentialing applications to ensure accuracy, completeness, and compliance with all accreditation standards.
- Performed primary source verifications such as criminal histories, licenses and board certifications.
- Processed re-credentialing applications for existing providers according to contractual requirements.
- Completed enrollments into Medicaid, Medicare and private insurance plans.
- Attended meetings and seminars related to healthcare industry regulations and trends.
Patient Care Coordinator
Hillsboro Pediatric Clinic
Hillsboro
10.2018 - 10.2019
- Coordinated patient appointments and managed scheduling for healthcare providers.
- Assisted patients with insurance verification and financial inquiries.
- Maintained accurate patient records in electronic health record systems.
- Communicated effectively with medical staff to ensure seamless patient care.
- Handled incoming calls and responded to patient inquiries promptly.
- Implemented office procedures to enhance operational efficiency in the clinic.
- Maintained accurate records of all patient care activities using electronic health record systems.
- Scheduled appointments for patients and coordinated follow-up visits as needed.
- Assisted in creating a positive environment for patients, family members, and staff by providing excellent customer service.
- Established strong work network by building professional relationships with physicians and fellow employees.
- Ensured that all necessary documentation was completed accurately and submitted in a timely manner.
- Provided administrative support for patient care staff.
- Processed patient intake information and updated medical records prior to treatment.
Call Center Representative
Virginia Garcia Memorial Health Center
Hillsboro
09.2016 - 08.2018
- Handled customer inquiries through phone, email, and chat support channels.
- Resolved customer issues by following company protocols and procedures.
- Collaborated with team members to share best practices and improve service quality.
- Provided product information and troubleshooting assistance to enhance customer satisfaction.
- Answered incoming calls and provided highest level of professionalism and knowledgeable service to every customer.
- Maintained high levels of professionalism while interacting with customers via phone or email.
- Answered, screened and processed high volume of calls daily with call management system and web-based communications.
- Managed appointment bookings and ensured timely communication with clients.
- Collaborated with team members to streamline scheduling processes and reduce conflicts.
- Utilized scheduling software to organize daily operations and track appointments.
- Maintained accurate records of appointments and schedule changes for reference.
- Utilized MS Office and Excel to analyze data and create spreadsheets.
- Maintained up-to-date records of staff availability, absences, holidays, vacations.
Front Desk/Intern
Healthy Birth Initiative
Portland
05.2016 - 12.2016
- Managed patient check-ins and appointment scheduling efficiently.
- Answered multi-line phone system, directing calls to appropriate staff.
- Maintained accurate patient records utilizing electronic health record systems.
- Coordinated with medical staff to ensure smooth patient flow and communication.
- Provided exceptional customer service, addressing patient inquiries and concerns effectively.
- Organized office supplies and maintained cleanliness of reception area daily.
- Called patients to confirm scheduled appointments and obtain additional details.
- Greeted patients, verified insurance information and collected copays.
- Checked patients in and out for appointments and collected co-payments.
Education
High School Diploma -
Hillsboro High School
Hillsboro06-2012
Skills
- MDStaff software
- Credentialing processes
- Regulatory compliance
- Primary source verification
- Team leadership
- Workflow improvement
- Data management
- Effective communication
- Process improvement
- Employee training
- Healthcare enrollment
- Task prioritization
- Problem-solving
- Multitasking
Accomplishments
- Medical Administration Certificate -2016
Timeline
Credentialing Team Lead
Virginia Garcia Memorial Health Center
03.2023 - Current
Credentialing Specialist
Virginia Garcia Memorial Health Center
09.2022 - 03.2023
Patient Care Coordinator
Hillsboro Pediatric Clinic
10.2018 - 10.2019
Call Center Representative
Virginia Garcia Memorial Health Center
09.2016 - 08.2018
Front Desk/Intern
Healthy Birth Initiative
05.2016 - 12.2016
High School Diploma -
Hillsboro High School
Similar Profiles
Jordyn ThomasJordyn Thomas
EFDA/Student Mentor at Virginia Garcia Memorial Health CenterEFDA/Student Mentor at Virginia Garcia Memorial Health Center
Christian EstradaChristian Estrada
Shadowing Student at Virginia Garcia Memorial Health CenterShadowing Student at Virginia Garcia Memorial Health Center
Ramon Nunez LopezRamon Nunez Lopez
Pharmacy Technician at Virginia Garcia Memorial Health CenterPharmacy Technician at Virginia Garcia Memorial Health Center
Kiara RuedaKiara Rueda
Medical Assistant at Virginia Garcia Memorial Health CenterMedical Assistant at Virginia Garcia Memorial Health Center
Don IrvineDon Irvine
Installation Technician at Johnson ControlsInstallation Technician at Johnson Controls