Summary
Overview
Work History
Education
Skills
References
Timeline
Generic

Gabrielle James

Dickinson

Summary

Enthusiastic Credentialing Specialist with proven track record in managing credentialing operations and ensuring compliance. Valued for strong collaborative skills and achieving results through efficient processes. Utilizes effective communication and meticulous documentation to manage credentialing for healthcare providers. Known for adaptability and reliability in dynamic environments, with expertise in documentation and regulatory standards.


Overview

10
10
years of professional experience

Work History

Credentialing Specialist

Gen4 Dental Partners
01.2025 - Current
  • Manage credentialing processes for dental practices and providers over multiple States and specialties, ensuring compliance with regulatory standards.
  • Develop strong relationships with payers and practices, leading to increased cooperation during the onboarding and credentialing process.
  • Manage multiple priorities effectively, resulting in the on-time completion of credentialing tasks for numerous providers simultaneously.
  • Verify provider credentials including education, licensure, board certifications, work history, and malpractice coverage.
  • Manage NPI registration and updates via NPPES and maintain CAQH profiles.
  • Conduct audits of provider files, ensuring all necessary documents are up-to-date and compliant with regulatory requirements.
  • Communicate with providers, payers, and internal departments to resolve credentialing issues.
  • Submit enrollment applications to commercial and government payers ensuring compliance with State and payer requirements.

Senior Billing and Credentialing Specialist

Enable Dental
03.2021 - 01.2025
  • Review and process credentialing applications to ensure accuracy, completeness, and compliance with all accreditation standards.
  • Maintain detailed records of provider data in CAQH and internal credentialing database system.
  • Perform initial review for new providers to determine eligibility for enrollment into the network and re-credentialing.
  • Participate in periodic audits of credentialing files to maintain compliance with applicable regulations and policies.
  • Interact regularly with representatives from health plans, PACE programs, and Business Development Executive team regarding credentialing matters.
  • Lead and develop training material for new policies, procedures, and contracts.
  • Responsible for learning and understanding new CRMs to effectively create SOPs to train the departments during multiple system migrations.
  • Implemented the billing process to organize the Skilled Nursing Facilities Dental IME workflow, utilizing spreadsheets to minimize outstanding aging for 150 facilities.
  • Maintain excellent working relationships with internal and external contacts to ensure an optimal level of service.
  • Address any questions that may arise regarding billing statements and insurance with exceptional customer service.
  • Proactively follows up on outstanding balances via phone, email, and mail, and adds detailed notes in charts to have a record of conversations and collection attempts.
  • Verify insurance benefits, send insurance claims, pre-authorizations, review EOB and payments.
  • Process payments, send statements, update and audit patient charts, and thorough follow-up as needed.
  • Interview, recruit, and train job applicants for the billing department.
  • Assists the Director of Revenue with special projects such as creating and inputting insurance plans, reporting, and encouraging the team to reach monthly billing goals.
  • Conducts employee performance reviews, makes recommendations for merit increases, and provides feedback.

Licensed Sales Agent

State Farm
07.2020 - 02.2021
  • Provide prompt, accurate, and friendly customer service to new and existing business.
  • Reach out to customers regarding their insurance needs and assist in finding the best product that fits their needs in property and casualty, as well as life and health products.
  • Meet weekly/monthly marketing and premium goals set by the Agent.
  • Prepare forms, policies, and endorsements when required.
  • Assist customer in setting up billing for new and existing policies.
  • Explained policy terms and conditions to clients in a clear, concise manner.

Assistant Front Office Manager

Omni Austin Downtown
05.2019 - 07.2020
  • Improve staff productivity by establishing incentives for reaching volume goals.
  • Reduced financial pushback on miscellaneous sales pertaining to guests' billing by implementing new procedures to ensure thoroughness.
  • Inspect weekly labor schedules to ensure all departments are within budget payroll, and enough coverage based on occupancy demands.
  • Conducted daily briefing sessions with front office staff to review occupancy status, arrivals and departures, special requests and VIP guests.
  • Assisted the Front Office Manager in developing, implementing and monitoring operational policies and procedures.
  • Coached and counseled employees to enhance performance and eliminate process lags.
  • Managed customer complaints and rectified issues to complete satisfaction.
  • Monitored front desk staff performance, ensuring adherence to company standards.
  • Maintained accurate records of guest accounts using property management system.

Assistant General Manager

Holiday Inn Express
01.2018 - 05.2019
  • Prior to opening the hotel, I led the team in several projects to prepare the property and ensure that the hotel opening deadline was met weeks in advance.
  • Provided end-of-month audits of the hotel to Executive Management, as required.
  • Ensured that guest complaints were handled in the most effective manner possible, and that complimentary services were offered for hardship cases.
  • Hired and mentored all new employees, while also demonstrating the best methods for servicing clients and guests.
  • Worked closely with team members to deliver project requirements, develop solutions, and meet deadlines.
  • Monitored cash intake to eliminate discrepancies.
  • Adjusted rates and weekly schedules for staff based on occupancy and upcoming events, with minimum night stay restrictions, to ensure maximum profitability.
  • Monitored inventory levels and placed orders for new supplies and breakfast items while being mindful of cost and budgets.
  • Provided training, guidance, and support to staff members on proper procedures and policies.
  • Motivated and led team members to work together to achieve targets.

Front Office Manager/Sales

Hampton Inn and Suites Lubbock Southwest
01.2016 - 01.2018
  • Responsible for managing the daily operations of the front office, including greeting guests, answering phone calls and emails.
  • Provided leadership to ensure that all Front Office team members are delivering excellent customer service.
  • Assisted in recruiting, training, evaluating and developing staff members in order to maintain high standards of performance.
  • Professionally and efficiently resolved guest complaints and problems, with exceptional customer service.
  • Incorporate new ideas to push customer service and cleanliness scores to maintain the highest quality of guest experience.
  • Managed inventory levels for supplies used at the front desk and breakfast area, such as stationary items, key cards, and breakfast items.
  • Create group blocks into the Rates and Inventory with shoulder dates, room counts, and rates.
  • Inspect weekly labor schedules to ensure all departments are within budget payroll, as listed in the budgets and forecasts.
  • Manage daily, weekly, and monthly inventory procedures along with proper auditing procedures and outline corrective action.

Education

High School Diploma -

Hendrickson High School
Pflugerville, TX
05-2013

Skills

  • Detail Oriented
  • Data and Time Management
  • Accuracy and Precision
  • Critical Thinking and Problem Solving
  • Adobe, Word, Excel Knowledge
  • Provider Enrollment
  • Application Management
  • Credential My Doc, Fresh Service, CareStack software expertise

References

References available upon request.

Timeline

Credentialing Specialist

Gen4 Dental Partners
01.2025 - Current

Senior Billing and Credentialing Specialist

Enable Dental
03.2021 - 01.2025

Licensed Sales Agent

State Farm
07.2020 - 02.2021

Assistant Front Office Manager

Omni Austin Downtown
05.2019 - 07.2020

Assistant General Manager

Holiday Inn Express
01.2018 - 05.2019

Front Office Manager/Sales

Hampton Inn and Suites Lubbock Southwest
01.2016 - 01.2018

High School Diploma -

Hendrickson High School

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