Dayonna Colbert
Suisun,CA
Summary
Detail-oriented Credentialing Specialist with hands-on experience performing provider credentialing and recredentialing activities within a health plan environment. Experienced in reviewing and validating healthcare practitioner documentation, conducting primary source verification, researching discrepancies, monitoring provider information, and maintaining accurate credentialing records. Proficient in CAQH, IntelliCred, NPPES, Microsoft Office, and multiple databases. Strong written and verbal communication skills with demonstrated ability to follow up with providers and internal teams, manage competing deadlines, maintain confidentiality, and consistently support quality and production standards.
Overview
11
11
years of professional experience
Work History
Credentialing Specialist
TEKsystems — Assigned to Partnership HealthPlan of California
Fairfield, CA
04.2025 - Current
- Perform provider credentialing and recredentialing activities in accordance with organizational policies, procedures, and regulatory and accreditation standards.
- Review and process initial and recredentialing applications, verifying completeness, accuracy, and required supporting documentation.
- Conduct primary source verification of provider licenses, board certifications, education, training, work history, professional liability insurance, DEA registrations, and other required credentials.
- Research discrepancies and follow up with providers, representatives, and internal departments to obtain missing or updated information and facilitate timely credentialing decisions.
- Monitor provider credentials and conduct sanction and exclusion screenings through federal and state databases, including OIG, SAM, and other required sources.
- Maintain and update provider profiles in CAQH and utilize IntelliCred to manage workflows, track application status, and document credentialing activities.
- Communicate with providers and internal teams by phone and email regarding required documentation and credentialing deficiencies.
- Manage multiple provider files and competing deadlines while maintaining accuracy, confidentiality, quality, and productivity standards.
Verification Specialist
Ehealth
Remote, Ca
04.2024 - 04.2025
- Assisted Medicare beneficiaries with enrollment in Medicare Advantage, Prescription Drug, and other managed care plans through a licensed third-party brokerage.
- Verified beneficiary eligibility, demographic information, and enrollment status to ensure accurate and compliant application processing.
- Reviewed plan options, benefits, coverage, costs, and enrollment requirements and communicated information clearly to beneficiaries.
- Guided beneficiaries through enrollment processes, explaining documentation requirements, next steps, and expected timelines.
- Confirmed and updated beneficiary information to ensure accurate records and delivery of enrollment materials.
- Communicated with insurance companies and other parties to obtain and verify information necessary for enrollment processing
Claims Specialist – COVID-19 Rent Relief Program
Teksystems
Remote, Ca
04.2023 - 03.2024
- Reviewed and processed applications to determine eligibility in accordance with established program guidelines and policy requirements.
- Verified claimant information and evaluated supporting documentation for completeness, accuracy, and consistency.
- Researched missing or inconsistent information and contacted applicants by phone and email to obtain required documentation and clarify application details.
- Maintained accurate case records and documented communications, supporting documentation, and eligibility determinations.
- Applied policies and procedures consistently to make accurate and well-documented eligibility determinations.
- Managed multiple cases and competing deadlines while maintaining confidentiality, accuracy, and productivity.
Claims Processor- Unemployment Insurance
Aston Carter
Remote, Ca
01.2021 - 02.2023
- Reviewed and processed unemployment insurance claims by verifying claimant wages, employment history, and eligibility in accordance with state and federal requirements.
- Conducted detailed eligibility determinations by researching wage records, claimant statements, employer information, and supporting documentation.
- Contacted employers and claimants to verify information, obtain additional documentation, and clarify discrepancies.
- Interviewed claimants and employers to gather relevant information and support accurate and timely claim determinations.
- Explained eligibility requirements, documentation requests, appeals, and claims processing procedures to claimants.
- Maintained accurate records while handling multiple cases and sensitive information.
Loan Claims Processor
West America Bank
Fairfield
01.2016 - 12.2020
- Processed consumer loan applications by reviewing financial documentation for accuracy, completeness, and compliance with established policies and regulatory requirements.
- Verified applicant information, including income, employment, assets, credit history, and supporting documentation.
- Identified missing or inconsistent information and followed up to obtain required documentation.
- Provided professional customer service by answering questions, explaining documentation requirements, and communicating application status.
- Managed multiple files simultaneously while maintaining accuracy, organization, confidentiality, and attention to detail.
Education
High School Diploma -
Armijo High School
FairfieldSkills
- Provider Credentialing & Recredentialing
- Primary Source Verification
- Document review
- OIG & Sanction Screening
- License & Certification Verification
- Regulatory & Accreditation Compliance
- CAQH
- IntelliCred
- NPPES
- Document Research & Discrepancy Resolution
- Document research
- Provider Communication & Follow-Up
- Microsoft Office
- Attention to Detail
- Organization & Multitasking
- Written & Verbal Communication
Timeline
Credentialing Specialist
TEKsystems — Assigned to Partnership HealthPlan of California
04.2025 - Current
Verification Specialist
Ehealth
04.2024 - 04.2025
Claims Specialist – COVID-19 Rent Relief Program
Teksystems
04.2023 - 03.2024
Claims Processor- Unemployment Insurance
Aston Carter
01.2021 - 02.2023
Loan Claims Processor
West America Bank
01.2016 - 12.2020
High School Diploma -
Armijo High School