Summary
Overview
Work History
Education
Skills
Accomplishments
Affiliations
Timeline
Generic

Iris Hines

San Antonio,TX

Summary

Credentialing Specialist with extensive experience at Audie Murphy Veterans Hospital, recognized for expertise in insurance procedures and a collaborative management approach. Demonstrated success in optimizing credentialing processes to achieve regulatory compliance and enhance operational efficiency. Proficient in database management and HIPAA compliance, dedicated to advancing community health initiatives.

Overview

12
12
years of professional experience

Work History

Credentialing Specialist

Audie Murphy Veterans Hospital
San Antonio, TX
02.2022 - Current
  • Reviewed and processed credentialing applications to ensure accuracy, completeness, and compliance with all accreditation standards.
  • Validated primary source documents such as licenses, diplomas, certifications and other related credentials.
  • Maintained detailed records of provider data in the credentialing database system.
  • Performed initial review for new providers to determine eligibility for enrollment into the network.
  • Ensured timely completion of credentialing processes by providing guidance to providers on required documentation.
  • Participated in periodic audits of credentialing files to maintain compliance with applicable regulations and policies.
  • Conducted background checks on potential providers utilizing various resources including state licensing boards, OIG and GSA Exclusion List, NPDB.
  • Coordinated with internal departments such as medical staff services or risk management to resolve any issues identified during the verification process.
  • Processed re-credentialing applications for existing providers according to contractual requirements.
  • Developed reports related to provider demographic information, status changes, verifications completed, as requested by management or external customers.
  • Collaborated with internal teams regarding provider contracts and agreements.
  • Provided support in responding to inquiries from external parties regarding credentialing information.
  • Interacted regularly with representatives from health plans and commercial payers regarding credentialing matters.
  • Prepared correspondence for various departments concerning credentialing updates or requests for additional information.
  • Served as a resource person for staff members seeking assistance in understanding complex regulatory requirements related to provider enrollment processes.
  • Attended meetings and seminars related to healthcare industry regulations and trends.
  • Participated actively in special projects or initiatives pertaining to improvement of operational efficiency within the department.
  • Confirmed facility and user credentials to initiate and maintain registration and enrollment processes.
  • Checked applications for missing information and organized all paperwork.
  • Maintained informational resources, tracking and documenting requests for updates, certification and credentialing.
  • Set up NPI numbers for providers and facilities and updated current profile information.
  • Trained junior credentialing staff on best practices and company-specific procedures.
  • Provided guidance and support to new providers throughout the credentialing process.
  • Performed primary source verifications such as criminal histories, licenses and board certifications.
  • Performed database queries, compiling information according to requests and logging logistics changes.
  • Processed documents and status-change requests, conducting followup assessment regarding enrollment inquiries.
  • Organized records to prepare for site visits by representatives and associated audits.
  • Addressed and resolved discrepancies in provider documentation during credentialing.
  • Maintained up-to-date records of credentialing statuses in database systems.
  • Monitored expiration of licenses and certifications, notifying providers of renewal requirements.
  • Coordinated with healthcare professionals to collect necessary documentation for credentialing.
  • Prepared and submitted detailed reports on credentialing progress to management.
  • Facilitated communication between departments to resolve credentialing issues efficiently.
  • Negotiated with credentialing services vendors to secure cost-effective solutions.
  • Updated credentialing software with new features to enhance process efficiency.
  • Developed and implemented credentialing policies and procedures to improve workflow.
  • Conducted regular audits of credentialing files to ensure accuracy and completeness.
  • Ensured strict confidentiality of provider information in accordance with HIPAA regulations.
  • Responded to verification inquiries from other healthcare organizations and insurance companies.
  • Managed end-to-end provider credentialing process, ensuring compliance with industry standards.
  • Analyzed employment-related data and prepared reports.
  • Maintained and updated organizational charts, employee handbooks or performance evaluation forms.
  • Maintained current knowledge of equal employment opportunity and affirmative action guidelines and laws.
  • Participated in credentialing committees, presenting cases and making recommendations.
  • Conferred with management to develop or implement personnel policies or procedures.
  • Prepared or maintained employment records using human resources management system software.
  • Interpreted and explained human resources policies, procedures or regulations.

Lead Medical Support Assistant

Orlando VA Medical Center
Orlando, FL
11.2020 - 02.2022
  • Provided administrative support to the medical team and patients, including scheduling appointments, filing patient records, and answering phones.
  • Maintained a clean and safe environment in the clinic by stocking supplies and cleaning exam rooms.
  • Assisted physicians with exams, treatments, and procedures as needed.
  • Performed laboratory procedures such as drawing blood or collecting specimens.
  • Managed daily operations of the clinic while providing excellent customer service to all visitors.
  • Scheduled follow-up appointments for patients based on their individual needs.
  • Verified insurance eligibility prior to appointment scheduling.
  • Conducted health risk assessments on new patients before they were seen by a provider.
  • Ensured that all necessary paperwork was completed accurately prior to patient discharge.
  • Responded promptly to inquiries from staff members regarding patient care issues.
  • Processed insurance claims in a timely manner to ensure prompt payment for services rendered.
  • Verified accurate patient demographic and insurance information to enter into electronic medical system.
  • Answered telephone calls, recording accurate messages and relaying to designated staff.
  • Communicated pertinent information and potential problems to physicians and nurses.
  • Scheduled appointments for patients via phone and in person.
  • Relayed messages from patients to physicians about concerns, condition updates or refill requests to facilitate treatment.
  • Organized charts, documents and supplies to maintain team productivity.
  • Secured patient information and maintained patient confidence by completing and safeguarding medical records.
  • Participated in team meetings to improve workflows and contribute to improving patient population outcomes.
  • Answered phones, scheduled appointments, greeted patients and ordered supplies.
  • Conducted patient interviews to gather health history, vital signs and information about current medical issues.
  • Verified appointment times with patients, preparing charts, pre-admission and consent forms.
  • Kept facility stocked with necessary supplies, equipment and instruments.
  • Oversaw patient registration, insurance verification, form completion and appointment scheduling to maintain operational efficiency.
  • Handled general office duties to support administrative staff during peak hours.
  • Assisted back office patient processes to reduce office wait times.
  • Processed orders for medical supplies and lab equipment.

Advanced Medical Support Assistant

West Palm Beach Va Medical Center
West Palm Beach, FL
08.2019 - 11.2020
  • Assisted with the scheduling of patient appointments and follow-up visits.
  • Maintained accurate records of patient medical history, medications, test results, and other pertinent information in electronic health record system.
  • Performed administrative tasks such as filing, faxing, photocopying and scanning documents.
  • Provided support to physicians by entering orders into the computerized order entry system accurately.
  • Greeted patients upon arrival and directed them to their destination within the facility.
  • Answered phone calls from patients or healthcare providers and responded to inquiries professionally.
  • Verified patient insurance coverage for services rendered at the facility.
  • Assisted with billing processes related to healthcare services provided by physicians.
  • Processed prior authorization requests for specialty medications according to established protocols.
  • Served as a liaison between patients and healthcare providers by providing information on policies, procedures, benefits and other relevant topics.
  • Ordered laboratory tests and diagnostic studies requested by physicians in accordance with protocol guidelines.
  • Ensured that all necessary forms were completed correctly prior to patient discharge.
  • Conducted quality assurance checks on medical charts to ensure accuracy of documentation.
  • Provided assistance with inventory control including ordering supplies as needed.
  • Coordinated care plans between various departments of the hospital or clinic setting.
  • Attended staff meetings regularly to stay up-to-date on changes in policy or procedure regulations.
  • Updated outdated patient information to maintain current records.
  • Scheduled appointments for medical procedures and physician consultations with patients.
  • Scheduled appointments for patients via phone and in person.
  • Secured patient information and maintained patient confidence by completing and safeguarding medical records.
  • Relayed messages from patients to physicians about concerns, condition updates or refill requests to facilitate treatment.
  • Participated in team meetings to improve workflows and contribute to improving patient population outcomes.
  • Organized charts, documents and supplies to maintain team productivity.
  • Responded to patient callbacks and phone-in prescription refill requests.
  • Answered phones, scheduled appointments, greeted patients and ordered supplies.
  • Kept facility stocked with necessary supplies, equipment and instruments.
  • Oversaw patient registration, insurance verification, form completion and appointment scheduling to maintain operational efficiency.
  • Handled general office duties to support administrative staff during peak hours.
  • Assisted back office patient processes to reduce office wait times.
  • Supported administrative staff by processing payments.
  • Processed orders for medical supplies and lab equipment.

Advanced Medical Support Assistant

VA Health Care System
Tallahassee, FL
11.2018 - 02.2020
  • Assisted with the scheduling of patient appointments and follow-up visits.
  • Maintained accurate records of patient medical history, medications, test results, and other pertinent information in electronic health record system.
  • Performed administrative tasks such as filing, faxing, photocopying and scanning documents.
  • Provided support to physicians by entering orders into the computerized order entry system accurately.
  • Greeted patients upon arrival and directed them to their destination within the facility.
  • Answered phone calls from patients or healthcare providers and responded to inquiries professionally.
  • Verified patient insurance coverage for services rendered at the facility.
  • Served as a liaison between patients and healthcare providers by providing information on policies, procedures, benefits and other relevant topics.
  • Ensured that all necessary forms were completed correctly prior to patient discharge.
  • Conducted quality assurance checks on medical charts to ensure accuracy of documentation.
  • Provided assistance with inventory control including ordering supplies as needed.
  • Coordinated care plans between various departments of the hospital or clinic setting.
  • Attended staff meetings regularly to stay up-to-date on changes in policy or procedure regulations.
  • Updated outdated patient information to maintain current records.
  • Scheduled appointments for medical procedures and physician consultations with patients.
  • Retrieved patient files for doctors.
  • Scheduled appointments for patients via phone and in person.
  • Secured patient information and maintained patient confidence by completing and safeguarding medical records.
  • Participated in team meetings to improve workflows and contribute to improving patient population outcomes.
  • Organized charts, documents and supplies to maintain team productivity.
  • Responded to patient callbacks and phone-in prescription refill requests.
  • Answered phones, scheduled appointments, greeted patients and ordered supplies.
  • Verified appointment times with patients, preparing charts, pre-admission and consent forms.
  • Kept facility stocked with necessary supplies, equipment and instruments.
  • Oversaw patient registration, insurance verification, form completion and appointment scheduling to maintain operational efficiency.
  • Handled general office duties to support administrative staff during peak hours.

Advanced Medical Support Assistant

Truman VA Medical Center
Columbia, MO
03.2017 - 11.2019
  • Assisted with the scheduling of patient appointments and follow-up visits.
  • Maintained accurate records of patient medical history, medications, test results, and other pertinent information in electronic health record system.
  • Performed administrative tasks such as filing, faxing, photocopying and scanning documents.
  • Provided support to physicians by entering orders into the computerized order entry system accurately.
  • Greeted patients upon arrival and directed them to their destination within the facility.
  • Answered phone calls from patients or healthcare providers and responded to inquiries professionally.
  • Verified patient insurance coverage for services rendered at the facility.
  • Processed prior authorization requests for specialty medications according to established protocols.
  • Served as a liaison between patients and healthcare providers by providing information on policies, procedures, benefits and other relevant topics.
  • Ordered laboratory tests and diagnostic studies requested by physicians in accordance with protocol guidelines.
  • Ensured that all necessary forms were completed correctly prior to patient discharge.
  • Conducted quality assurance checks on medical charts to ensure accuracy of documentation.
  • Coordinated care plans between various departments of the hospital or clinic setting.
  • Attended staff meetings regularly to stay up-to-date on changes in policy or procedure regulations.
  • Updated outdated patient information to maintain current records.
  • Scheduled appointments for medical procedures and physician consultations with patients.
  • Scheduled appointments for patients via phone and in person.
  • Secured patient information and maintained patient confidence by completing and safeguarding medical records.
  • Participated in team meetings to improve workflows and contribute to improving patient population outcomes.
  • Organized charts, documents and supplies to maintain team productivity.
  • Relayed messages from patients to physicians about concerns, condition updates or refill requests to facilitate treatment.
  • Responded to patient callbacks and phone-in prescription refill requests.
  • Interviewed and engaged patients to obtain medical history, chief complaints and vital signs.
  • Answered phones, scheduled appointments, greeted patients and ordered supplies.
  • Conducted patient interviews to gather health history, vital signs and information about current medical issues.
  • Verified appointment times with patients, preparing charts, pre-admission and consent forms.
  • Oversaw patient registration, insurance verification, form completion and appointment scheduling to maintain operational efficiency.
  • Handled general office duties to support administrative staff during peak hours.
  • Collected, labeled and stored laboratory specimens properly prior to testing.
  • Assisted back office patient processes to reduce office wait times.
  • Processed orders for medical supplies and lab equipment.
  • Contacted medical facilities to schedule patients for admission.

Census Field Supervisor

Census Bureau
Tallahassee, FL
03.2019 - 09.2019
  • Coordinated and managed field staff to ensure accurate completion of census operations.
  • Supervised training of enumerators on data collection procedures, regulations, and guidelines.
  • Developed detailed work plans for recruitment, interviewing, and canvassing activities.
  • Ensured quality assurance standards were met by monitoring the accuracy of data collected in the field.
  • Organized and facilitated meetings with local government agencies to discuss census operations.
  • Conducted weekly site visits to check progress of census operations in assigned areas.
  • Provided technical assistance to enumerators regarding complex cases or difficult households.
  • Resolved problems related to survey administration and addressed public inquiries about census operations.
  • Recruited enumerators from a variety of sources including community organizations and job centers.
  • Monitored daily performance reports to identify potential discrepancies in data collection efforts.
  • Created strategies for improving response rates in hard-to-reach communities or areas with low response rates.
  • Managed workflow processes between teams in order to ensure timely completion of tasks.
  • Maintained records related to personnel management such as time sheets, payroll documents, leave requests.
  • Developed policies and procedures for conducting interviews with respondents.
  • Prepared reports summarizing results of surveys conducted by field staff.
  • Analyzed survey results for trends or patterns that could impact census operations.
  • Provided guidance on interpreting regulations related to census taking activities.
  • Tracked expenditures associated with fieldwork activities and prepared budget summaries for review.
  • Identified opportunities for streamlining existing processes in order to increase efficiency.
  • Collaborated with other departments within the organization on initiatives involving data collection methods or practices.
  • Provided leadership, insight and mentoring to newly hired employees to supply knowledge of various company programs.
  • Remained calm and professional in stressful circumstances and effectively diffused tense situations.
  • Completed thorough opening, closing, and shift change functions to maintain operational standards each day.
  • Resolved customer inquiries and complaints requiring management-level escalation.
  • Delegated work to staff, setting priorities and goals.
  • Recruited and trained new employees to meet job requirements.
  • Reviewed completed work to verify consistency, quality, and conformance.
  • Assigned work and monitored performance of project personnel.
  • Produced thorough, accurate and timely reports of project activities.
  • Interviewed prospective employees and provided input to HR on hiring decisions.
  • Held regular one-on-one meetings with employees to review performance and priorities and provide feedback.
  • Evaluated individual and team business performance and identified opportunities for improvement.
  • Planned and led team meetings to review business results and communicate new and ongoing priorities.
  • Mediated conflicts between employees and facilitated effective resolutions to disputes.
  • Planned and delivered training sessions to improve employee effectiveness and address areas of weakness.
  • Analyzed business performance data and forecasted business results for upper management.
  • Organized team activities to build camaraderie and foster pleasant workplace culture.
  • Proposed or approved modifications to project plans.
  • Created and managed budgets for travel, training, and team-building activities.
  • Implemented quality control measures to uphold company standards.

Medical Social Worker

State of Florida Department of Health
Fort Lauderdale, FL
02.2013 - 02.2017
  • Provided psychosocial assessments to patients and their families.
  • Facilitated referrals to community resources, such as housing or financial assistance programs.
  • Conducted individual and family counseling sessions for clients with mental health issues.
  • Collaborated with other healthcare professionals to create treatment plans for patients.
  • Developed group therapy activities in order to promote socialization and self-care skills among participants.
  • Assisted physicians in determining the best course of action for medically complex cases.
  • Coordinated discharge planning services, including arranging transportation and home care assistance after hospitalization.
  • Created educational materials on topics related to medical social work, such as grief counseling or end-of-life care.
  • Educated caregivers about the importance of providing emotional support to patients during illness or recovery periods.
  • Maintained detailed records regarding patient progress, clinical interventions and case notes in accordance with HIPAA regulations.
  • Provided crisis intervention services when needed, such as suicide prevention or substance abuse counseling.
  • Monitored patient compliance with prescribed treatments, medications and follow-up appointments.
  • Advised patients and their families on available options for long-term care placement facilities or hospice services.
  • Assessed client's strengths and weaknesses in order to identify areas that need improvement or further development.
  • Participated in interdisciplinary team meetings to discuss patient needs and plan appropriate interventions.
  • Acted as an advocate for vulnerable populations by connecting them with essential resources within the community.
  • Initiated contact with local agencies and organizations to ensure access to quality healthcare services.
  • Established relationships with external providers who could provide additional support when necessary.
  • Counseled individuals suffering from chronic illnesses on how best to manage symptoms while maintaining a positive outlook on life.
  • Facilitated support groups for those coping with terminal illnesses or dealing with bereavement issues.
  • Coordinated psychosocial assessments, treatment plans and progress notes.
  • Maintained confidential case documentation.
  • Maintained thorough case history records and wrote detailed reports.
  • Documented services and collected required data for evaluation.
  • Compiled socio-psychiatric case histories to facilitate accurate diagnoses.
  • Guided clients in development of skills and strategies for dealing with individual problems.
  • Addressed barriers to care, including transportation, financial issues, and language barriers.
  • Participated in research projects focused on improving patient outcomes.
  • Coordinated discharge planning to ensure continuity of care post-hospitalization.
  • Guided patients and families through the healthcare system, including insurance processes.
  • Advocated for patient rights and services within the healthcare system.
  • Educated patients and families on coping strategies for dealing with illness and hospitalization.
  • Utilized evidence-based practices to inform interventions and care plans.
  • Developed and implemented training programs for hospital staff on psychosocial issues.
  • Facilitated access to community resources and services for patients and families.
  • Developed individualized care plans in collaboration with healthcare teams.
  • Liaised with community agencies to enhance service provision and referrals.
  • Conducted home visits for assessments and to provide additional support.
  • Conducted comprehensive psychosocial assessments to identify patient needs and strengths.
  • Monitored and evaluated the effectiveness of social work interventions.
  • Led support groups for patients dealing with chronic illnesses and their caregivers.
  • Assisted in the development of hospital policies related to patient care and social services.
  • Provided crisis intervention and emotional support to patients and their families.
  • Maintained detailed records of patient interactions, assessments, and plans.
  • Collaborated with other professionals to assess client needs.
  • Referred client or family to appropriate community resources to obtain support for mental or physical illness.
  • Educated clients on options to assist in making informed decisions.
  • Provided information to access financial assistance, legal aid or housing.
  • Advocated for clients to resolve medical or personal crises.
  • Planned and coordinated discharge from care facility to patient's home.
  • Tracked patient or client care and followed through to provide service effectiveness.
  • Identified environmental challenges to client progress through interviews with patient and caregivers.
  • Monitored and evaluated client progress compared to measurable treatment and care plan goals.
  • Utilized data and experience to coordinate patient care and rehabilitation.
  • Modified treatment plans to accommodate changes in clients' health or progress.
  • Organized support groups to help families understand and support client or patient.
  • Transported patients safely to social activities and doctors appointments.
  • Counseled clients or patients individually and in group sessions to assist recovery from illness and to adjust to life.
  • Advised on policy development and assisted in community program implementation.
  • Supervised other workers and caregivers providing services to clients.

Education

Master of Science - Social Work

Walden University
Minneapolis, MN

MBA - Business Administration And Management

University of Phoenix
Tempe, AZ
08-2006

Bachelor of Arts - Sociology/ Social Work

Bloomfield College
Bloomfield, NJ
05-1994

Skills

  • Insurance procedures
  • Credentialing documentation
  • Background check
  • Management collaboration
  • Document review
  • Regulatory compliance
  • Report generation
  • Background checks
  • Data management
  • HIPAA compliance
  • Application management
  • License verifications
  • Credential verification
  • Credentialing oversight
  • Proofreading
  • Facility credentialing
  • Database maintenance
  • Accreditation information management
  • Community health center credentialing

Accomplishments

  • Honor Society
  • Member of National Association of Social Workers (NASW)

Affiliations

  • Member of National Association of Social Workers (NASW)
  • OES

Timeline

Credentialing Specialist

Audie Murphy Veterans Hospital
02.2022 - Current

Lead Medical Support Assistant

Orlando VA Medical Center
11.2020 - 02.2022

Advanced Medical Support Assistant

West Palm Beach Va Medical Center
08.2019 - 11.2020

Census Field Supervisor

Census Bureau
03.2019 - 09.2019

Advanced Medical Support Assistant

VA Health Care System
11.2018 - 02.2020

Advanced Medical Support Assistant

Truman VA Medical Center
03.2017 - 11.2019

Medical Social Worker

State of Florida Department of Health
02.2013 - 02.2017

Master of Science - Social Work

Walden University

MBA - Business Administration And Management

University of Phoenix

Bachelor of Arts - Sociology/ Social Work

Bloomfield College

Similar Profiles

  • Kristopher Johnson

    Kristopher JohnsonKristopher Johnson

    Medical Supply Technician at Audie Murphy Veterans HospitalMedical Supply Technician at Audie Murphy Veterans Hospital

    View Profile
  • Karen Angell

    Karen AngellKaren Angell

    Medical Supply Technician (Logistics) at Audie Murphy Veterans HospitalMedical Supply Technician (Logistics) at Audie Murphy Veterans Hospital

    View Profile
  • Scott Peterson

    Scott PetersonScott Peterson

    Emergency Room Registered Nurse at Parker Indian HospitalEmergency Room Registered Nurse at Parker Indian Hospital

    View Profile
Iris Hines