Gabriela Wirkus

Supported the credentialing and recredentialing process for healthcare providers across multiple specialties and states by reviewing provider applications, verifying credentials, researching regulatory requirements, and maintaining accurate provider records. Collaborated with providers, insurance companies, and internal teams to resolve documentation discrepancies, ensure compliance with HIPAA, NCQA, CMS, and payer guidelines, and maintain timely credentialing workflows. Demonstrated strong analytical, organizational, and customer service skills while managing high volumes of confidential information, prioritizing competing deadlines, and navigating multiple healthcare systems to support accurate provider data and operational efficiency.

Key Responsibilities & Achievements

• Reviewed and processed initial credentialing and recredentialing applications for physicians, dentists, physician assistants, nurse practitioners, therapists, and other healthcare providers.
• Verified professional licenses, board certifications, DEA registrations, malpractice coverage, education, training, work history, and other credentialing documentation.
• Researched provider information using state licensing boards, the National Practitioner Data Bank (NPDB), CAQH, and payer portals.
• Communicated directly with providers, practice managers, hospitals, and insurance companies to obtain missing documentation and resolve credentialing issues.
• Maintained accurate provider records within credentialing databases while ensuring HIPAA compliance and data integrity.
• Tracked credentialing deadlines, expirations, renewals, and application status using Microsoft Excel and electronic tracking systems.
• Investigated documentation discrepancies and worked collaboratively with internal departments to achieve timely resolution.
• Prepared provider files for committee review and payer enrollment submissions.
• Assisted with provider enrollment, demographic updates, and maintenance of provider information.
• Maintained detailed documentation of provider communications, follow-up activities, and credentialing progress.
• Supported credentialing operations across multiple specialties, provider groups, and multiple states.
• Prioritized a high-volume workload while consistently meeting production goals and turnaround times.
• Utilized Microsoft Excel, Word, Outlook, Adobe Acrobat, and multiple web-based healthcare systems daily.
• Assisted with internal audits by ensuring provider files met regulatory and accreditation standards.
• Developed strong working relationships with providers through professional communication, responsiveness, and exceptional customer service.

Provided compassionate, person-centered support to individuals receiving behavioral health services while maintaining a safe, structured, and therapeutic environment. Collaborated closely with multidisciplinary healthcare teams to implement individualized treatment plans, document patient progress, and ensure compliance with organizational policies and HIPAA regulations. Demonstrated strong communication, problem-solving, and organizational skills by managing multiple responsibilities, accurately maintaining clinical documentation, responding effectively during high-pressure situations, and building positive relationships with patients, families, and healthcare professionals.

Key Responsibilities & Achievements

• Monitored patient behavior and documented observations, progress notes, and incident reports accurately and in a timely manner.
• Assisted in implementing individualized treatment plans under the direction of licensed healthcare professionals.
• Maintained detailed and confidential patient records in compliance with HIPAA and organizational standards.
• Communicated professionally with patients, families, nurses, physicians, therapists, and other members of the healthcare team.
• Utilized de-escalation and conflict-resolution techniques to manage challenging situations while ensuring patient safety.
• Observed changes in patient behavior and promptly reported concerns to clinical staff.
• Assisted patients with daily living activities while promoting independence and dignity.
• Maintained a safe, supportive, and therapeutic environment for patients.
• Prioritized multiple tasks and adapted quickly in a fast-paced healthcare setting.
• Ensured accuracy when completing documentation and following established procedures.
• Demonstrated exceptional attention to detail while maintaining compliance with facility policies and healthcare regulations.
• Built trusting relationships through empathy, active listening, and excellent customer service.
• Collaborated with interdisciplinary teams to coordinate patient care and improve treatment outcomes.
• Responded calmly and effectively during crisis situations while maintaining professionalism.
• Developed strong time management, organizational, and critical-thinking skills through managing multiple responsibilities simultaneously.
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Delivered compassionate care and daily support to residents in a long-term care setting while promoting their safety, comfort, and independence. Collaborated with nurses, healthcare professionals, residents, and family members to ensure quality care, maintain accurate documentation, and provide exceptional customer service. Demonstrated strong organizational, communication, and time-management skills while balancing multiple responsibilities, maintaining confidentiality, and following healthcare regulations and facility policies.

Key Responsibilities & Achievements

• Assisted residents with activities of daily living, including personal care, mobility, and meal assistance, while preserving dignity and independence.
• Documented resident care, observations, and changes in condition accurately and promptly.
• Assisted with medication administration and maintained accurate medication documentation in accordance with facility policies and state regulations.
• Communicated effectively with nurses, physicians, residents, family members, and interdisciplinary healthcare teams regarding resident needs and concerns.
• Monitored residents for changes in physical or emotional condition and reported concerns promptly to nursing staff.
• Maintained confidential resident information in compliance with HIPAA regulations.
• Prioritized multiple responsibilities while providing compassionate, high-quality care in a fast-paced healthcare environment.
• Responded professionally to resident and family questions, concerns, and requests, delivering exceptional customer service.
• Ensured compliance with facility policies, infection control procedures, and resident safety standards.
• Assisted in maintaining accurate records, completing required documentation, and supporting regulatory compliance.
• Worked collaboratively with healthcare team members to improve resident care and overall quality of service.
• Demonstrated excellent attention to detail, dependability, and professionalism while managing competing priorities and meeting daily responsibilities.