Dariana Zamora

• Efficiently coordinate and streamline the enrollment processes for employed providers and hospital enrollments, with specialization in managing 18 out-of-state Medicaid enrollments
• Proactively follow up every two weeks upon submission of applications to ensure a timely and accurate process
• Conduct thorough research for each out-of-state Medicaid application, thereby enabling the implementation of training policies and procedures for the Provider Enrollment Team
• This ensures meticulous accuracy in submitting enrollments and minimizes revenue delays
• Skillfully link providers with active out-of-state Medicaid facility enrollments to successfully process claims
• Maintain a vigilant track of revalidation's for both providers and facilities, thereby ensuring up-to- date licenses and tracking down CLIA certifications, JCAHOS accreditations, and other necessary credentials
• Diligently manage the workload from the EPIC work queue for the Enrollment Team, ensuring everyone receives updated enrollments and fostering efficient workflows.

I was honored to lead the credentialing department, overseeing commercial and government insurance processes. My responsibilities included effectively reporting financial enrollment increases, enrolling clinics and hospitals in both government and commercial insurance programs to secure reimbursements. I successfully managed the participation of 4 hospitals and 16 clinics in these programs.

• Managed contract providers in 25 out-of-state Medicaid enrollments, ensuring hospitals receive revenue for services rendered to patients
• Skillfully requested surrogacy access through the I&A system and diligently updated providers' NPPES profiles
• Proven track record of enrolling providers in Medicare through PECOS by submitting accurate CMS-855I and CMS-855R forms, while also keeping providers' revalidation's up to date
• Expertly handled backdated enrollments for both Medicaid and Medicare, ensuring proper submission
• Efficiently maintained providers' CAQH profiles and completed necessary attestations every 4 months.

• My role involved effectively credentialing healthcare providers, ensuring their eligibility to deliver professional healthcare services to patients
• This encompassed processing thorough background checks, verifying employment and work history, and conducting diligent OIG checks to identify any red flags that could hinder a physician's ability to provide care
• Additionally, I diligently maintained and updated physicians' CAQH profiles, ensuring all attestations remained up to date
• In addition, I successfully enrolled providers in Medicaid and Medicare programs
• This involved utilizing the Medicaid Colorado portal and submitting both paper and electronic PECOs applications
• I also ensured accurate linkage of providers to their designated facilities in the Medicaid portal and processed backdated enrollments when necessary
• Overall, my contributions in these areas played a pivotal role in ensuring compliant and efficient healthcare service delivery for patients and the smooth operation of healthcare facilities.

• As an office coordinator my duties included, coordinating resident schedules, opening, and closing or creating new slots through Soarian EMR software
• Assisting getting authorizations for patient referrals
• Scheduling patients and rescheduling appointments
• Keeping track of office medical accommodating patient with any of their needs to keep patient satisfactory.

• As a Medical Assistant, my main responsibilities include triaging patients for the physician, which involves assessing their medical conditions and prioritizing their needs
• I also check patients' weight, blood pressure, and perform blood draws as prescribed by healthcare providers
• In addition, I update patients' charts with any new medications and symptoms they may be experiencing and schedule future appointments
• I also assist in obtaining prior authorizations for medications and medical procedures
• Furthermore, I call patients to confirm upcoming appointments and conduct audits of patient files prior to their visit to ensure a smooth and successful appointment.