ERICA RANGEL
Sanger,Tx
Summary
Seeking a rewarding position where my extensive experience will be fully utilized in providing quality and efficient support to the company's needs while providing growth and advancement opportunities
Overview
19
19
years of professional experience
Work History
Credentialing Manager
Ellie Mental Health
02.2023 - 11.2024
- Oversee all credentialing functions including application management for over 20 franchises for the state of Texas, Tennessee, Oklahoma and Arizona collectively
- Facilitate weekly meetings with team to provide support and coordinate application submissions for all payer panels including Medicare and Texas Medicaid
- Facilitate meetings with franchise owners and Clinical Directors as requested to discuss insurance payer statuses
- Ensure that we obtain required legal documents such as copy of state license, W-9, Certificate of Insurance etc for application submissions
- Review and complete contracts from insurance payers such as Cigna, Aetna, BCBS and UHC prior to signature
- Communicate daily with insurance payers via phone or email to request and obtain application status for all providers
- Confirm networks approved and request fee schedules as needed
- Track and keep provider credentialing status up to date in Modio platform
- Ensure providers are 100% in compliance with credentialing policies by updateing CAQH as needed and attesting
- Train newly hired Credentialing Managers and provide ongoing support for all credentialing functions
Customer Service Manager
Zoetis Inc
07.2019 - 02.2023
- Provided excellent customer service to program members in inbound call center
- Defused escalated calls as needed and escalated calls to management as needed
- Resolved member concerns/complaints
- Trained newly hired customer service agents
- Actively monitored staff engagement; utilized team chat daily to assist agents
- Evaluated staff performance and provided coaching
- Monitored queues to verify call metrics
- Conducted interviews for potential new hires
- Assisted with performance reviews for each team representative
- Coordinated monthly team meetings
Customer Service Representative/Clinical Coordinator
Value Options/Beacon Health Options
07.2005 - 12.2016
- Delivered exceptional customer service to program members, providers, and pharmacies in inbound call center.
- Addressed inquiries from potential new members about mental health and chemical dependency services.
- Referred critical calls to care managers and crisis team for assessment and to maintain safety.
- Worked closely with onsite doctor daily with the prior authorization requests of medications for members and communicated approvals/denials with in-network pharmacies and providers
- Tracked approvals and denials of medication requests in database
- Processed and recorded clinician-approved mental health packages efficiently.
- Performed data entry for clinical member information.
- Engaged in managing quality processes addressing member grievances and objections.
- Researched member and provider inquiries concerning eligibility, benefits, and claims.
- Upheld and outperformed established performance standards for the department.
- Adhered to company policy and HIPAA guidelines safeguarding member information.
Education
BACHELOR OF SCIENCE - SOCIAL WORK
UNIVERSITY OF NORTH TEXAS
05.2019
ASSOCIATE OF SCIENCE -
BROOKHAVEN COMMUNITY COLLEGE
12.2017
Skills
- EOB Knowledge
- CPT & ICD-9 codes experience
- Billing/Claims Processing Experience
- Basic knowledge of SQL
- Proficient in Jira/Confluence
- Bilingual English/Spanish
- Excellent communication skills
- Organized and detail oriented
- Proficient in Macess & EZ-Cap
- Proficient in MS Office (Word, Excel, & PowerPoint)
- Leadership and training experience
- Strong client service focus
- Team player
- Type 75 WPM
- Proficient in Modio, Sharepoint & CAQH
- Proficient in SalesForce & Service Connect
Timeline
Credentialing Manager
Ellie Mental Health
02.2023 - 11.2024
Customer Service Manager
Zoetis Inc
07.2019 - 02.2023
Customer Service Representative/Clinical Coordinator
Value Options/Beacon Health Options
07.2005 - 12.2016
BACHELOR OF SCIENCE - SOCIAL WORK
UNIVERSITY OF NORTH TEXAS
ASSOCIATE OF SCIENCE -
BROOKHAVEN COMMUNITY COLLEGE
Similar Profiles
Grace HenryGrace Henry
Outpatient Mental Health Therapist at Ellie Mental Health- Space CoastOutpatient Mental Health Therapist at Ellie Mental Health- Space Coast
Hadlee BrunsHadlee Bruns
Mental Health Therapist at Ellie Mental HealthMental Health Therapist at Ellie Mental Health
Paige AanestadPaige Aanestad
School-Based Mental Health Practitioner at Ellie Mental HealthSchool-Based Mental Health Practitioner at Ellie Mental Health
CHRISTINA PRICECHRISTINA PRICE
Billing Specialist at Ellie Mental HealthBilling Specialist at Ellie Mental Health
Dawn GilletteDawn Gillette
Founder at DMG Bookkeeping, LLCFounder at DMG Bookkeeping, LLC