Jessica Canto
Miami,FL
Summary
Experience Reliable and highly skilled Credentialing Supervisor with broad and deep knowledge of the healthcare industry. Extraordinary professional communication skills with staff patients and relevant government regulators. Able to function well as an independent worker or as part of a medical clerical team. Learning new concepts quickly, working well under pressure, and communicating ideas clearly and effectively Attentive to detail Interpersonal communication. Auditing applications Oversee primary source verifications Assist in various projects Perform quality checks Payment posting Leadership and Development Highly organized Medical Claims Processing Knowledge with NCQA Standards Policy and Procedure Development Mergers and Acquisitions Training and Development
Overview
14
14
years of professional experience
Work History
Credentialing Supervisor
Elevate ENT Partners
12.2022 - Current
- Manage Team
- Submit Medicare and Medicaid applications
- Be responsible for credentialing and re-credentialing of all providers through primary source verifications (e.g., NPDB, Boards, AMA, National Student Clearinghouse, various licensing agencies MSO and Medical
- Internship, Residency and Fellowship schools)
- Assists Manager in development and fulfillment of short/long term departmental goals
- Create ACHA accounts
- Run Service Fund Downloads
- Acquisition Credentialing
- Handle / Create CAQH accounts
- Payor Enrollment
- Chart Reviews
- Malpractice Renewals
- Contractual Billing/ Claims issues
- Managed Care updates
Credentialing Team Lead
Envision Physician Services
Plantation, FL
05.2010 - 11.2022
- Generates and manages various reports for management, implementing best practices and working on projects as assigned
- Educates and informs faculty and division personnel about credentialing policies and procedures internally
- Establish and maintain positive & effective communication with providers and management
- Maintenance of provider files so they contain the necessary and complete credentialing documentation
- Establish internal processes, policy and procedures, and workflows to ensure effective and efficient practice operations
- Serve as the person responsible for processing credentials files that contain dated accurate approved content on time, verify a professional history, communicate the status directly to providers and administrators and meet regulations
- Be responsible for credentialing and re-credentialing of all providers through primary source verifications (e.g., NPDB, Boards, AMA, National Student Clearinghouse, various licensing agencies MSO and Medical
- Internship, Residency and Fellowship schools)
- Develop long-term professional relationships with Physicians, Practice Managers, and Leadership team
- Monitors credentialing, re-credentialing, and ongoing monitoring processes, ensuring compliance with regulatory bodies NCQA, CMS, as well as by laws policies, procedures, and delegated contracts
- Mastery of the credentialing application process with commercial carriers and government programs
- Collaborate with healthcare providers and management team to implement new strategies
- Create and maintain provider files in compliance with the organization’s policies
- Assists Manager in development and fulfillment of short/long term departmental goals
- Customer Service
- Respond to customer inquiries
- Managed a team of 10 telephone operators
- Assist with refunds
- Resolve customer complaints
- Process payment
- Locate and notify insurance companies of short paid claims
- Ran monthly reports on short paid claims
- Insurance claim preparation and submission
- Appeal claim denials
- Posted payments for Self- pay patients and insurance payments
- Opened mail and deposited checks through RDSO
- Adjusted accounts
- Batch preparation for posting
Education
Masters of Business Administration -
Florida International University
08.2020
Bachelors of Business Administration and -
Miami Dade College
05.2017
Excel, Microsoft Outlook, AS-400, MSOW, Certifications Lean Six Sigma Certification- Yellow Belt College credit Certificate- Business Specialist – Human Resources -
Skills
- Motivational Leadership
- Decision Making
- Relationship Building
- Coaching and Mentoring
- Complex Problem Solving
- Microsoft Office
- Staff Development and Training
- Performance Management
- Multitasking and Organization
- Handling Complaints
- Customer Service
- Team Leadership
- Team Management and Supervision
- Team Building
- Workflow Optimization
- Facility Credentialing
- License Verifications
- Delegation and Work Assignment
- Phone and Email Etiquette
- Administration and Operations
- Remote Work Coordination
Languages
English
Native/ Bilingual
Spanish
Native/ Bilingual
Timeline
Credentialing Supervisor
Elevate ENT Partners
12.2022 - Current
Credentialing Team Lead
Envision Physician Services
05.2010 - 11.2022
Masters of Business Administration -
Florida International University
Bachelors of Business Administration and -
Miami Dade College
Excel, Microsoft Outlook, AS-400, MSOW, Certifications Lean Six Sigma Certification- Yellow Belt College credit Certificate- Business Specialist – Human Resources -
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