Elva Tamayo
Menifee,CA
Summary
Experienced Credentialing Coordinator with background in managing credentialing processes for healthcare professionals. Skills include thorough knowledge of NCQA standards and Medicare/Medicaid regulations, ability to maintain provider database, and coordination of committee meetings. Strengths lie in effective communication, problem-solving capabilities, and adaptability to fast-paced work environments. Prior roles demonstrated impact through improved efficiency in the credentialing process and successful maintenance of high compliance rates.
Overview
12
12
years of professional experience
Work History
Credentialing Coordinator
LifeStance Health
Menifee, CA
06.2020 - 11.2024
- Kept close tabs on documentation expiration dates, communicating with correct personnel to submit files prior to expiration.
- Maintained detailed database of compliance data, activities and actions taken.
- Managed multiple tasks simultaneously while meeting tight deadlines.
- Assisted with auditing processes for compliance purposes.
- Managed end-to-end provider credentialing process, ensuring compliance with industry standards.
- Reviewed and processed applications to verify accuracy of credentialing information.
- Collected fees and application documentation for licenses and issued paperwork for follow-up actions.
- Conducted thorough background checks and verified educational and professional qualifications.
- Collaborated with other organizations to obtain required documents for verification purposes.
- Followed up with relevant agencies for status updates on submitted applications.
- Followed up with licensees to verify adherence to requirements.
- Collected and reviewed data to identify potential compliance issues requiring further review.
- Coordinated with healthcare professionals to collect necessary documentation for credentialing.
- Set up NPI numbers for providers and facilities and updated current profile information.
- Managed confidential files related to each provider's credentials.
- Monitored and tracked progress of credentialing applications to ensure timely completion.
Front Office Coordinator
Psycare/LifeStance Health
San Diego, California
12.2015 - 06.2020
- Assisted with ordering supplies as needed.
- Verified accuracy of information before entering it into the database system.
- Monitored waiting area, ensuring cleanliness and compliance with safety protocols.
- Managed multi-line telephone system, efficiently directing incoming calls to appropriate departments.
- Responded to messages and emails to the office and transferred correspondence.
- Scheduled appointments for clients and visitors.
- Managed front desk operations during shifts worked.
- Coordinated with other supervisors, combining group efforts to achieve goals.
- Maintained accurate records of all incoming and outgoing correspondence.
- Maintained patient records with strict adherence to confidentiality and privacy regulations.
- Attended training sessions to stay updated on new policies and procedures.
- Resolved customer complaints or answered customers' questions.
- Updated customer contact information in database systems.
- Greeted and assisted visitors, providing exceptional customer service and maintaining a welcoming environment.
- Performed administrative support tasks, completing duties within required timeframes.
- Processed payments from clients in a timely manner.
- Responded to customer inquiries via telephone or email in a professional manner.
- Managed office supply inventory, placing orders and controlling costs.
Workers' Compensation Coordinator
Health Care Recovery
La Mesa, California
10.2012 - 11.2015
- Drafted letters to claimants informing them of their rights under the Workers' Compensation Act.
- Researched employee benefit and health and safety practices, recommending changes or modifications to existing policies.
- Coordinated communication between employers, insurance carriers, attorneys and medical providers regarding the status of all open workers' compensation cases.
- Maintained records on employee injuries, illnesses, treatments, and related expenses.
- Analyzed financial data related to workers' compensation claims in order to identify any potential areas of cost savings.
- Negotiated collective agreements on behalf of employers or workers and mediated labor disputes and grievances.
- Determined liability, compensability, and benefits due on each claim.
Education
GED -
Chula Vista High School
Chula Vista, CA10-2003
Skills
- HIPAA compliance
- Credentialing software
- Re-credentialing processes
- Records and file management
- Provider enrollment
- License verifications
- Provider relations
- Insurance procedures
- Credentialing oversight
- Credentialing documentation
- Application coordination
- Document review
Timeline
Credentialing Coordinator
LifeStance Health
06.2020 - 11.2024
Front Office Coordinator
Psycare/LifeStance Health
12.2015 - 06.2020
Workers' Compensation Coordinator
Health Care Recovery
10.2012 - 11.2015
GED -
Chula Vista High School