Deonna Salinas
Savannah,TX
Summary
Results-driven professional with over 13 years of expertise in delegated credentialing and provider enrollment, specializing in streamlining processes that align with NCQA and JCAHO standards. Proven ability to deliver implementable efficiencies across organizations, enhancing operational effectiveness and compliance. Extensive background in credentialing and enrollment across more than 40 states provides a versatile and highly applicable skill set that drives organizational success. Committed to fostering collaborative environments that support continuous improvement and excellence in healthcare services.
Overview
12
12
years of professional experience
Work History
Provider Enrollment Specialist
Coronis Health
08.2022 - Current
- Oversee hospital credentialing and enrollment processes for multiple medical and behavioral health clinics/facilities, managing all affiliated providers. Supervise a team of global offshore specialists, ensuring accurate application handling and primary source verifications. Conduct weekly client meetings to address updates and escalate any concerns. Generate and distribute weekly payer reports, providing detailed enrollment status, approvals, and maintenance updates through systems such as Modio and CAQH.
Delegated Credentialing Specialist ( Contractor)
Texas Health Physicians Group
08.2023 - Current
- Manage onboarding, credentialing maintenance, and Credentials Committee coordination for all Texas Health Breeze Urgent Care providers. Audit Plans Process delegated credentialing applications for both government/commercial health plan payers and managed the ongoing participation requirements of the plans for all practitioners enrolled. Facilitate presentation of credentialing and recredentialing to the Credentialing Committee and any other applicable approving body/authority; completes all post-approval notifications, data entry, and system updates. Populate, maintain, and update the credentialing software to ensure accountability for the integrity of information entered the system. Assist with coordination of audit activity for certifications (NCQA, URAC) and third-party audits (payors, self-insureds, carriers, etc.) for both initial and concurrent audits for delegated credentialing services; also includes monitoring program compliance with contractual terms and effective enforcement of operational provisions. Validate the renewal of "Expireables"(e.g. board certifications, licenses, etc.) as needed. Collaborate with Credentialing team to establish policies and procedures for credentialing and re-credentialing standards of THPG, THUC; Ensure accuracy of source documentation and system logs related to credentialing activities; Monitor compliance with state and federal regulations and accreditation standards. Onboard urgent care providers utilizing md app, maintain all delegation agreements, license updates, plan audits.
Provider Enrollment Coordinator
Signify Health
04.2020 - 08.2023
- Trained and helped manager lead a team of 15 employees, supporting rapid organizational growth to 65,000 providers, with 300–400 new providers onboarded weekly. Initiated all phases of provider enrollment for regions assigned, re-enrollment and expirables management ensuring the timely and accurate enrollment (and revalidations) of providers in commercial & government payers Medicaid and Medicare for 40 states. Contracting and credentialing knowledge to complete group revalidations for multiple medicaid states, perform data entry and database reports through MD Stafff and virtus. Created Medicaid manuals for over 12 States for enrollment purposes. Maintained the timelines on enrollments processed, communicated with providers and other departments to update as needed and claim corrections/retrodates, clarify enrollment information requirements based on state requirements and maintain a strict level of confidentiality for all matters pertaining to provider credentials. Coordinated credentialing data needed for enrollment, contracting, and other related purposes. Worked closely with providers to obtain signatures and missing documentation related to enrollment and contracts.
Credentialing Coordinator
Signify Health
10.2019 - 04.2020
- Ran queries to appropriate organizations and evaluated responses to ensure provider compliance with NCQA standards. Established and maintained a system for timely processing of credentialing/re-credentialing files in accordance with NCQA policies. Maintained up to date credentialing database. Reviewed and processed credentialing and re-credentialing files. Maintained copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers. Maintained professionalism at all times when communicating credentialing and/or background concerns with any provider. Assembled all verified information and prepared files for presentation to the Credentialing Committee. Assisted with ongoing monitoring of contracted providers. Reviewed all background screenings and recorded results. Utilized the MD Staff credentialing database, optimizing efficiency, and performed query, report and document generation. Monitored the initial, re-credentialing and expirables process. Assisted with special projects. Verified providers' requirements for approval to work in specific states. Provided administrative support to Director of Medical Staff Services and Credentialing Manager. Actively demonstrated teamwork. Approved plan-specific provider assignments in Virtus. Responded for monthly audits. Responded to requests from various internal departments. Managed Nppes accounts for providers with approval and CAQH profiles for plan and committee approval.
Credentialing Manager
NM Family Services LLC
07.2018 - 03.2020
- Screened new hire providers for medical and behavioral positions, conducted initial interviews and scheduled appointments for official interviews. Red flagged any potential background check concerns and pulled reports from the national provider data bank, Texas OIG. Submitted initial NM License applications for new providers. Prepared and submitted all credentialing applications to the MCO's and all marketplace insurance plans in NM. Monitored all license expiries and renewed online as well as facility licenses and practices. Maintained provider files electronically for audits. Closely communicated with providers on any concerns with credentialing, provider enrollment and obtaining credentials. Obtained contracts for NM Health Plans for 3 clinics, maintained group revalidations and delegated rosters for health plans.
Credentialing Specialist
Emergence Health Network
05.2013 - 07.2017
- Initiated and supported the practitioner application process by sending, receiving, and analyzing practitioner documents and data import to determine completeness in preparation for the credentials verification process. I was responsible for gathering, verifying evaluating highly confidential and sensitive health care practitioner credentials consistent with departmental guidelines to NCQA and Joint Commission accreditation standards as well as delegated credentialing. I efficiently performed all aspects of credentialing verification, including initial credentialing and recredentialing to ensure current credentials and timely handoff and/or review and approval of practitioner files. Maintained CAQH profiles for all providers to ensure plan approvals with health plans contracted. Actively participated and lead team meetings and processed improvement initiatives to continuously improve work product quality and efficiency. Prepared Medicare connection requests, sent medicare 855I and 855R applications to link providers to groups, initiated new enrollments for Medicaid and all TX, NM health plan enrollments for contracted payors. Utilized anasazi and Cactus to store all information required to maintain daily duties. Provided monthly reports of all approvals and pending approvals while working closely with the Billing department to resolve or dispute claim denials to improve reimbursement.
Credentialing Specialist- Temp
Quick Claimers Medical Billing, Inc.
02.2017 - 07.2017
- Ensured that clinics, individual contracted providers complied with federal and state regulations regarding licensure and certification of medical professionals. Maintained data for all providers in the facility and tracked expiration of certifications, CMEs, and applied for Medicaid Medicare indemnification numbers. Ensured that healthcare providers updated their certification or licensing on time along with malpractice insurance up to date and if any board actions; investigated present or outcome of action. Created newly graduated providers with National provider identifiers, updated locations, added providers to existing contracts, and applied for all required MCO's in the states of Texas and New Mexico depending on licensure or degree of provider. Maintained CAQH for all providers and sent monthly reports to the credentialing manager that are Re-credentialed and credentialed providers. Completed all hospital privilege packets for all providers that were due for initial credentialing and recredentialing in the surrounding hospitals for NM, and TX. Completed group contracts with medicare, medicaid and marketplace health plans for providers that paid for our services.
Medical Debt Collector-Temp Job
Burnett Staffing- Resp Med
01.2017 - 04.2017
- Posted payments from all account activity within the clinic into the Medact medical billing system. Handled adjustments with patient accounts includes; allowables and inputting the deductibles, contractual write offs as necessary. Processed patient's credit card payments, and check deposits for payment on accounts. Created work orders to confirm payments on accounts with ongoing patients for supplies. Routinely collaborated with account managers to obtain proper charges with patients. Understanding and following insurance guidelines for proper payment posting guidelines. Monitored insurance claim denials, while identifying patient over payments and processing them correctly into Medact. Identified credits, write offs and provided documentation of proof to manager for approval.
Billing Administrator
Mesilla Valley Transportation
10.2014 - 01.2017
- Verified monthly billings and resolved any discrepancies in billing by checking it with the sale invoice, verifying data with AS400, providing support to customers. Maintained the account receivables group by collecting open invoices and helping to resolve any queries associated with it. Maintained billing reports by documentation of the invoices and revenue generated. In charge of OTR drivers and owner operators for DOT Random selections for rounded drug testing, assisted with customer service complaints and worked with law enforcement involving any accidents from company drivers. Assisted with gate passes for truck drivers, utilized AS400 to track driving routes, trucks related to toll fees, and drug testing sites for verification billing purposes. Assisted with compliance and DOT auditing. Pre-Pass Management: Managed 1,400 pre-pass devices across 14 states that comply with designated weigh stations, port of entries. Researched all trucks consistently for any suspicious activity. Activating devices and deactivating devices that were either lost or stolen.
Credentialing/Provider Enrollment Specialist
Provider Billing Services, LLC
05.2013 - 10.2015
- Contracted as a Credentialing and Provider Enrollment Coordinator for Emergence Health Network, and Sun City Behavioral Healthcare as well as other private clinics. I was responsible for leading, coordinating, monitoring and maintaining the credentialing and re-credentialing process for all medical and behavioral providers. Initiated group contracts for TX and NM Medicaid, Medicare and health plans. Enrolled all individual providers under groups. Prepared hospital privilege credentialing packets for local hospitals in El Paso TX and Presbyterian New Mexico. Applied for NPI's for newly approved providers, managed CAQH profiles and all license renewals and expirables, worked with MCO's and delegation rosters for selected facilities.
Education
Bachelor of Arts - Forensic Psychology
Southern New Hampshire University
Manchester, NH01-2018
Medical Office
Kaplan College
El Paso, TX12.2014
Medical Assistant
Kaplan College
El Paso, TX12.2012
Associates of Arts - Education
El Paso Community College
El Paso, TX05.2010
Skills
- Extensive knowledge of initial and recredentialing processes, provider enrollment for Medicaid, Medicare, and MCOs across 40 states
- Skilled in NPDB, US OIG, OFAC verifications, background checks, and exclusions list reviews
- Skilled in pre-filling Medical staff applications for provider privileging and onboarding
- Proficient in CAQH and NPPES databases
- Strong understanding of insurance plans and managed care enrollment requirements
Credentialing & Enrollment Expertise
- Experience in training teams and verifying provider credentials
- Credentialing Systems: MD Staff, Cactus, Modio, Credential Verity, Virtus
- Medical Software: Alta Point, Anasazi, Medisoft, Medact
- Productivity Tools: MS Excel, Outlook, PowerPoint, Google Sheets
Software Proficiency
Languages
English
Native or Bilingual
Spanish
Limited Working
Timeline
Delegated Credentialing Specialist ( Contractor)
Texas Health Physicians Group
08.2023 - Current
Provider Enrollment Specialist
Coronis Health
08.2022 - Current
Provider Enrollment Coordinator
Signify Health
04.2020 - 08.2023
Credentialing Coordinator
Signify Health
10.2019 - 04.2020
Credentialing Manager
NM Family Services LLC
07.2018 - 03.2020
Credentialing Specialist- Temp
Quick Claimers Medical Billing, Inc.
02.2017 - 07.2017
Medical Debt Collector-Temp Job
Burnett Staffing- Resp Med
01.2017 - 04.2017
Billing Administrator
Mesilla Valley Transportation
10.2014 - 01.2017
Credentialing Specialist
Emergence Health Network
05.2013 - 07.2017
Credentialing/Provider Enrollment Specialist
Provider Billing Services, LLC
05.2013 - 10.2015
Medical Office
Kaplan College
Medical Assistant
Kaplan College
Associates of Arts - Education
El Paso Community College
Bachelor of Arts - Forensic Psychology
Southern New Hampshire University
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