Guadalupe Arias
Healthcare Quality Auditor | Credentialing & Provider Data Specialist | Aspiring Epic HIM Analyst
Oak Brook
Summary
Dedicated health coordinator driving operational efficiency through quality assurance processes and data analysis. Proven ability to collaborate with cross-functional teams, ensuring compliance and enhancing organizational performance. Expertise in developing training materials that support system adoption and standardization.
Overview
15
15
years of professional experience
Work History
Provider Services Auditor
Advocate Aurora Health
Oak Brook
10.2025 - Current
- Supported internal and external audits (managed care and regulatory), ensuring documentation accuracy, audit readiness, and compliance adherence.
- Analyzed audit results and performance trends to identify gaps, implement corrective actions, and improve data accuracy and operational efficiency.
- Developed and maintained quality assurance processes, audits, and reporting workflows, ensuring compliance with regulatory and payer requirements.
- Collaborated with cross-functional teams and leadership to support quality initiatives and implement process improvements and system-related updates.
- Served as a subject matter expert in credentialing, provider data management, and government enrollment, ensuring data integrity across systems.
- Established and enforced documentation standards aligned with regulatory guidelines and organizational policies.
- Designed and delivered training materials, including e-learning modules and job aids, to support process standardization and system adoption.
Credentialing Coordinator
Advocate Aurora Health
Oak Brook
08.2022 - 10.2025
- Provided onboarding and enrollment support to new and existing practitioners for Advocate Physician Partners membership and contractual agreements with Advocate Medical Group, ensuring compliance and smooth integration.
- Provide weekly updates of practitioner changes to Advocate Physician Partners Network management.
- Facilitated communication between Credentials Verification Service and Medical Group to streamline credentialing processes and enhance collaboration.
- Assisted with timely updates of practitioner malpractice information, contributing to a comprehensive and accurate credentialing system.
Health Coordinator
Blue Cross Blue Shield of Illinois
Chicago
02.2020 - 08.2022
- Engaged members to provide information and education on medical management programs, researched data to inform best practices, addressed inquiries, and supported clinicians in Medical Management with provider and member activities.
- Trained new colleagues on procedures and best practices to ensure team alignment and effective onboarding.
- Coordinated health programs for diverse member populations across Illinois.
- Developed and implemented wellness initiatives to improve member engagement.
- Collaborated with healthcare providers to ensure quality service delivery.
Insurance Verifier
Advocate Aurora Health
Oak Brook
01.2019 - 02.2020
- Verifies insurance coverage for both incoming inpatient and observation patients transferring to any Advocate site in Illinois.
- Complies and reviews patient demographic and insurance information for accuracy and inputs it into company tracking-system.
- Pre-register all directed admissions through EPIC.
- Ran reports for all advocate hospitals to verify accuracy of admissions prior to discharge.
- Trained new team colleagues and provided resources for clinical team and physicians.
- Coded financial information and prepared documents for future reference and archival.
Central Scheduler
Advocate Good Samaritan Hospital
Downers Grove
08.2017 - 01.2019
- Scheduled patients for tests and consultations.
- Facilitated insurance approvals by processing necessary forms and scheduling procedures efficiently.
- Informed patients about appointment requirements and test preparation to enhance understanding and compliance.
- Executed administrative patient intakes, collecting case histories, insurance information, and mandated forms for accurate record-keeping.
- Managed financial documentations such as expense reports and invoices.
Medical Office Assistant
Advocate Health Care
Oak Lawn
04.2011 - 08.2017
- Fulfilled all Certified Medical Assistant duties in a fast-paced walk-in care clinic.
- Triaged patients, took vital signs, and assisted with comprehensive patient care.
- Assisted patients with walking, transfer, exam prep and all other needs.
- Received 95% positive reviews in post-visit patient surveys.
- Consistently adhered to HIPAA regulations to protect patient privacy.
- Assisted in developing Risk Management/Assessment protocols.
- Identified and helped correct five areas of elevated risk factors.
- Conducted proper and concise EMR documentation for all visits.
- Received, recorded, and filed medical payments by check, cash, and credit card.
Education
Medical Assistant Certificate -
Everest College
Merrionette Park, IL01-2009
High School Diploma -
Gurdon S. Hubbard High School
Chicago, IL01-2006
Healthcare Administration -
Devry University
Naperville, IL05-2026
Skills
- Insurance verification
- Billing
- ICD coding
- Compliance training
- Epic Systems
- EMR Outlook
- Records entry
- Scheduling
- Excel
- Microsoft office
- MDStaff
- Evolucion
- SmartUm
- Ecare
- MSOW
- Care Next
- Care Connection
- Troubleshooting
- Problem solving
- Adaptability
- Organizational skills
- 76 WPM
- Adobe
- Adaptability
Hobbies and Interests
- Dancing
- Travel
- Reading
- Nature
- Weightlifting
- Listen to different eras of music
Languages
Spanish
Limited
Timeline
Provider Services Auditor
Advocate Aurora Health
10.2025 - Current
Credentialing Coordinator
Advocate Aurora Health
08.2022 - 10.2025
Health Coordinator
Blue Cross Blue Shield of Illinois
02.2020 - 08.2022
Insurance Verifier
Advocate Aurora Health
01.2019 - 02.2020
Central Scheduler
Advocate Good Samaritan Hospital
08.2017 - 01.2019
Medical Office Assistant
Advocate Health Care
04.2011 - 08.2017
Medical Assistant Certificate -
Everest College
High School Diploma -
Gurdon S. Hubbard High School
Healthcare Administration -
Devry University