Jazmin Moya
Sunrise,FL
Summary
Experienced Credentialing Specialist adept at conducting application reviews and primary source verifications. Excellent relationship-building, problem-solving and communication skills. Known for adaptability and reliability in dynamic environments, with expertise in documentation and regulatory standards.
Overview
7
7
years of professional experience
Work History
Credentialing Professional
CarePlus Health Plans
08.2021 - Current
- Review credentialing applications to identify missing or inaccurate
information. - Maintain and update informational database housing provider and
facility documentation, used to process physicians who have been
de-credentialed and those needing re-credentialing. - Document provider's status throughout the credentialing process in
order to keep track of their progress. - Manage departmental mailbox in order to drive efficiency in
communication across multiple company departments. - Ensure credentialing policies and practices are updated and aligned
with Humana's processes and procedures. - Lead a monthly meeting with CarePlus and Humana representatives
to address roadblocks and concerns related to provider
credentialing. - Address and respond to member complaints and concerns related to
their visit to a providers office. - Collaborated with cross-functional teams to resolve discrepancies in provider credentials and licensure status.
- Developed training materials related to credentialing policies.
- Conducted audits of provider files, ensuring all necessary documents were up-to-date and compliant with regulatory requirements.
- Reduced errors in credentialing files by conducting thorough reviews and consistently maintaining attention to detail.
- Facilitated training sessions for new staff on credentialing processes, improving team efficiency.
- Assisted in preparing for audits, resulting in successful accreditation and recognition for compliance excellence.
Provider Installation Specialist
CarePlus Health Plans
06.2019 - 08.2021
- Made outbound calls to providers loaded in the CarePlus CSC system to
ensure accuracy of demographic information within our
database. - Addressed and responded to member complaints and concerns
with their provider visits. - Composed communications to address errors within the CSC
system with corresponding account executive. - Updated provider and facility information for accurate directory information.
Receptionist
Miami Lakes Automall
08.2018 - 06.2019
- Coordinated appointment scheduling for service departments, enhancing customer satisfaction and operational flow.
- Maintained organized reception area, ensuring a welcoming environment for clients and visitors.
- Operated multi-line telephone system to answer and direct high volume of calls.
- Resolved customer problems and complaints.
- Processed customer inquiries and resolved issues promptly, improving overall client experience.
- Handled cash transactions and maintained sales and payments records accurately.
Education
High School Diploma -
Hialeah Gardens Senior High School
Hialeah Gardens, FL06.2018
Skills
- Bilingual communication in English and Spanish
- Credentialing management systems
- Detail-oriented approach
- Knowledgeable in regulatory compliance
- Excellent time management and multitasking
- Training development
- Analytical problem solving
- Data confidentiality
- Cross-functional collaboration
- Effective organizational skills
Technical Acumen
- Microsoft Office Suite: Word, PowerPoint, Excel, and Outlook
- Microsoft SharePoint
- Workday
- Council for Affordable Quality Healthcare (CAQH)
- Provider at a Glance (PAAG)
Timeline
Credentialing Professional
CarePlus Health Plans
08.2021 - Current
Provider Installation Specialist
CarePlus Health Plans
06.2019 - 08.2021
Receptionist
Miami Lakes Automall
08.2018 - 06.2019
High School Diploma -
Hialeah Gardens Senior High School