Cynthia Mermea
San Antonio,TX
Summary
Dynamic Credentialing Specialist with proven success at Aetna, adept at enhancing processes and ensuring HIPAA compliance. Expert in provider enrollment and data management, achieving significant improvements in turnaround times. Strong problem-solver with exceptional provider relations skills, dedicated to maintaining high standards of accuracy and confidentiality in credentialing documentation.
Experienced with credentialing processes and regulatory compliance. Utilizes effective communication and meticulous documentation to manage credentialing for healthcare providers. Knowledge of industry standards and best practices ensures thorough and efficient credentialing operations.
Overview
8
8
years of professional experience
Work History
Credentialing Specialist
Cpa Medical Billing
10.2024 - 01.2025
- Collaborated with healthcare providers to gather necessary information for accurate credentialing decisions.
- Managed multiple priorities effectively, resulting in the on-time completion of credentialing tasks for numerous providers simultaneously.
- Conducted audits of provider files, ensuring all necessary documents were up-to-date and compliant with regulatory requirements.
- Enrolled providers and Medicaid, Medicare, and private insurance plans.
- Received and evaluated applications to look for missing and inaccurate information.
- Obtained NPI numbers for providers and facilities and updated existing profiles.
- Enhanced credentialing processes by streamlining documentation and verification procedures.
- Achieved greater accuracy in database management by regularly updating provider records and tracking status changes.
- Ensured compliance with industry standards by regularly updating policies and procedures related to credentialing.
- Maintained a thorough understanding of accreditation standards, enabling accurate interpretation of guidelines for staff members when needed.
- Implemented continuous improvement strategies for credentialing process, leading to more efficient operations.
- Improved turnaround time for credentialing applications by implementing an efficient online system.
- Managed credentialing files with strict adherence to confidentiality and privacy laws, ensuring secure handling of sensitive information.
- Collected and analyzed information to monitor compliance outcomes and identify and address trends of non-compliant behavior.
- Updated and maintained accurate records in credentialing databases, ensuring timely renewals and verifications.
- Increased departmental efficiency by developing and maintaining up-to-date credentialing policies and procedures.
- Improved provider satisfaction with efficient handling and processing of credentialing applications.
Credentialing Specialist
Aetna
09.2016 - 10.2024
- Collaborated with healthcare providers to gather necessary information for accurate credentialing decisions.
- Managed multiple priorities effectively, resulting in the on-time completion of credentialing tasks for numerous providers simultaneously.
- Conducted audits of provider files, ensuring all necessary documents were up-to-date and compliant with regulatory requirements.
- Enrolled providers and Medicaid, Medicare, and private insurance plans.
- Facilitated communication between departments, resulting in improved collaboration during the credentialing process.
- Demonstrated excellent problem-solving skills when confronted with complex issues or discrepancies during the credentialing process.
- Enhanced credentialing processes by streamlining documentation and verification procedures.
- Achieved greater accuracy in database management by regularly updating provider records and tracking status changes.
- Ensured compliance with industry standards by regularly updating policies and procedures related to credentialing.
- Provided exceptional customer service to both internal and external stakeholders, addressing inquiries promptly and professionally.
- Reduced errors in credentialing files by conducting thorough reviews and consistently maintaining attention to detail.
- Updated and maintained accurate records in credentialing databases, ensuring timely renewals and verifications.
- Collaborated with managers to identify and address employee relations issues.
- Advocated for staff members, helping to identify and resolve conflicts.
- Addressed and resolved discrepancies in provider documentation, maintaining high level of data integrity.
- Streamlined communication between departments, enhancing overall workflow and reducing processing times.
- Contributed to policy updates in response to changing healthcare regulations, ensuring ongoing compliance.
- Liaised with healthcare providers to address and resolve any credentialing issues promptly, maintaining strong professional relationships.
- Increased departmental efficiency by developing and maintaining up-to-date credentialing policies and procedures.
- Managed credentialing files with strict adherence to confidentiality and privacy laws, ensuring secure handling of sensitive information.
- Obtained NPI numbers for providers and facilities and updated existing profiles.
- Received and evaluated applications to look for missing and inaccurate information.
Education
Associate of Arts - Psychology
St Philips
San Antonio, TX06-2012
Skills
- HIPAA compliance
- Provider enrollment
- Background checks
- Data management
- Provider relations
- Credentialing oversight
- Document review
- Facility support
- Facility credentialing
- Credential verification
- Credentialing documentation
- Microsoft office
- Information protection
- Decision-making
- Proofreading
- License verifications
- Solo practitioner credentialing
- Data analysis
Timeline
Credentialing Specialist
Cpa Medical Billing
10.2024 - 01.2025
Credentialing Specialist
Aetna
09.2016 - 10.2024
Associate of Arts - Psychology
St Philips
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