Summary
Overview
Work History
Education
Skills
Certification
Timeline
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CHARISSE LAPENA

Canyon Country,CA

Summary

- Customer-focused professional with a proven track record of delivering exceptional customer service.

- Effective communicator skilled in fostering strong interpersonal relationships and collaborating within teams.

- Proficient in navigating customer-focused environments, with a deep understanding of provider enrollment and payer credentialing processes.

- Demonstrates proficiency in medical terminology, insurance claim processing, and ensuring compliance with HIPAA regulations.

- Adaptable team player capable of working independently or collaboratively to promptly achieve objectives and meet customer needs.

-Experienced Credentialing Specialist adept at conducting application reviews and primary source verifications.

Overview

14
14
years of professional experience
1
1
Certification

Work History

Credentialing Specialist, Sr

Carelon Behavioral Health
08.2021 - Current
  • Process 280-300 files daily with 99% accuracy and quality.
  • Conducted thorough verification of healthcare provider credentials, including licenses, certifications, education, training, and work experience, ensuring compliance with regulatory requirements
  • Collaborated with medical staff and administrative teams to facilitate credentialing process and maintain accurate provider records
  • Conducted regular internal audits to ensure accuracy and completeness of credentialing files, identifying and addressing any discrepancies promptly
  • Updated and maintained credentialing databases, ensuring all information was current and easily accessible
  • Assisted in developing and implementing process improvements to enhance efficiency and streamline credentialing process.

Payer Credentialing Coordinator / Billing Assistant

Henry Mayo Newhall Hospital
05.2021 - 08.2021
  • Facilitated the provider enrollment process for healthcare providers across multiple insurance networks
  • Prepared and submitted credentialing applications to payers, ensuring timely and accurate completion
  • Developed and maintained detailed credentialing records and databases, ensuring data accuracy and confidentiality
  • Supported the collection process by contacting customers for outstanding payments and providing outstanding customer service
  • Verify and process insurance claims for a diverse range of payers, ensuring accurate and timely submissions to maximize revenue generation.

Credentialing Coordinator II

Regal Medical Group
03.2017 - 05.2021
  • Communicated with healthcare providers and external entities to obtain necessary information and resolve any credentialing-related issues
  • Manage and oversee the entire payer enrollment process for the organization, including Medicare, Medicaid, commercial insurance, and managed care plans.
  • Exceptional phone communication skills, adept at conveying complex information clearly and empathetically
  • Customer-focused approach, consistently delivering outstanding service to providers, colleagues, and external stakeholders.

Medical Billing Assistant

Autism and Related Disorders
08.2016 - 03.2017
  • Assisted the billing department in data entry and documentation of patient billing information
  • Performed medical coding tasks under the guidance of senior billing staff
  • Gained practical experience in processing insurance claims and following up on denials
  • Provided exceptional customer service by addressing inquiries and resolving issues
  • Developed effective communication and problem-solving skills
  • Managed customer accounts and processed payments

Assistant Manager

Panda Express
03.2015 - 06.2016
  • Trained new team members on standard operating procedures, safety protocols, and customer engagement practices
  • Strong commitment to creating a customer-centric environment that drives positive experiences and loyalty
  • Adept at building and maintaining relationships with customers, ensuring their needs are met with utmost professionalism
  • Skilled communicator with a talent for resolving concerns and inquiries, resulting in improved customer retention
  • Demonstrated ability to develop and implement strategies that enhance the customer journey and increase sales
  • Proven track record in managing customer feedback and incorporating insights for continuous improvement.

Medical Receptionist

01.2010 - 09.2013
  • Welcomed patients and visitors, offering assistance and providing information about services
  • Managed appointment schedules and accommodated urgent and walk-in patients efficiently
  • Adept at managing high call volumes, addressing inquiries, scheduling appointments, and handling patient concerns
  • Strong interpersonal skills, fostering a friendly and professional atmosphere that puts patients at ease
  • Skilled in multi-tasking, handling patient check-ins, verifying insurance verification, eligibility and maintaining appointment schedules
  • Experienced in coordinating with medical staff to address patient needs promptly and efficiently.

Education

Master of Science (M.S - Healthcare Administration

Trident International
Costa Mesa, CA

Skills

  • Customer service
  • Outbound Calls
  • Data Entry
  • Problem Solving
  • Empathy
  • Provider Relations
  • Credentialing Policies
  • Active Listening
  • Client Satisfaction

Certification

NAMSS Certified Provider Credentialing Specialist (CPCS) LANGUAGES English, Tagalog LANGUAGE English Fluent Tagalog Fluent .

Timeline

Credentialing Specialist, Sr

Carelon Behavioral Health
08.2021 - Current

Payer Credentialing Coordinator / Billing Assistant

Henry Mayo Newhall Hospital
05.2021 - 08.2021

Credentialing Coordinator II

Regal Medical Group
03.2017 - 05.2021

Medical Billing Assistant

Autism and Related Disorders
08.2016 - 03.2017

Assistant Manager

Panda Express
03.2015 - 06.2016

Medical Receptionist

01.2010 - 09.2013

Master of Science (M.S - Healthcare Administration

Trident International

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CHARISSE LAPENA