Jessica Lopez
Springfield Gardens,NY
Summary
I seek a meaningful and challenging position in the medical field that will allow me to grow both professionally and personally while contributing to the organization's success. I am detail-oriented and proficient in various software applications, including Epic, VerityStream, Cactus, Cerner, IDX, Microsoft Word, Excel, Windows, and Outlook, as well as general Internet navigation.
I excel at providing quality customer service to physicians and patients in a fast-paced environment. I am self-motivated, a quick learner, reliable, and have excellent follow-through skills. My ability to adapt quickly to new responsibilities has made me a valuable team player with a positive attitude.
Overview
20
20
years of professional experience
Work History
Credentials Coordinator II
Mount Sinai Queens
12.2016 - Current
- Managed database updates for accurate record-keeping, ensuring timely renewals of licenses and certifications.
- Optimized workflow efficiency by automating routine tasks related to credentialing operations.
- Supported accreditation reviews by providing necessary documentation and organizing required materials.
- Developed relationships with licensing boards and regulatory agencies, facilitating prompt resolution of issues.
- Collaborated with department heads to identify areas for improvement in credentialing procedures.
- Prepared comprehensive reports for executive leadership on the current state of credentials management within the organization.
- Generate and disseminate provider rosters to delegated facilities, contracted group practices etc.
- Perform provider roster reconciliation
- Create, copy, file, and maintain all relevant documentation into provider credentialing folder.
- Maintain confidentiality of provider credentials by filing the credentialing folder
- Generate and disseminate monthly provider credentialing updates to appropriate departments and participating facilities and provider groups
- Review and respond to request for credentialing information/copies of credentialing files to appropriate
- Verify New York State license registration and DEA registration status for all credentialed providers in the
- Perform annual delegated file audits and participate in pre-delegation and delegation site reviews
- Respond to inquiries from other departments relative to a provider’s credentialing status
- Performs other related tasks as directed by the Deputy Chief Operating Officer or her designee, the
- Data entry and upkeep of provider information in the credentialing and other pertinent databases
Review provider re-credentialing and credentialing file for completion and presentation to the Credentialing - Group and Provider Medicaid revalidation application completion, assuring accuracy and timely delivery.
- Ensure enrollments for FPA providers in Medicaid Managed Care plans, Commercial Health plans as well as Medicaid & Medicare, including:
a. Organizing and reviewing applications for completeness and accuracy.
b. Collect physician’s credentials & signatures for paper applications and submit them to DelCred and Medicare/Medicaid team to ensure timely enrollments and changes.
Offsite Patient Coordinator
Mount Sinai Multispecialty Physicians
12.2012 - Current
- Prepare and submit all appropriate applications and required supporting documentation for medical providers
- Educate providers on credentialing and contracting guidelines and requirements
- Work closely with the insurances Provider Relations Dept
- On provider issues as needed
- Enter, maintain, and update provider information and documentation into CAQH credentialing database
- Responsible for updating and maintaining the providers insurance list on Excel
- Frequent contact with medical providers and practice managers to verify and obtain outstanding credentialing information including but not limited to Malpractice insurance policies, State Licenses, DEA certificates, and etc
- Assisted in maintaining physical credentialed provider files
- Tracks Providers expiration dates, mail renewal documents and maintain records regarding providers liability insurance
- Process applications and reappointment paperwork, checking for full completeness and accuracy
- Constantly maintain and update accurate databases for both practitioners and facilities
- Work effectively with other departments to ensure proper payment and claims processing
- Communicate with all levels of the organization, from front-desk team members, billing team members, practice managers, medical directors, and all providers
- Complete credentialing and re-credentialing applications
- Send notification to payers regarding new office opens and changes of office information
- Notify medical providers when state licenses and malpractice insurance certificates on file will expire
- Greet and assisted patients, guests, numerous visitors, including general public, and interview candidates
- Scheduled appointments for patients as requested by office staff or patients needs
- Answered phone calls and take messages or directed calls as necessary
- Posted patient's payments and balanced receipts at the end of shift
- Ensure patients understand office policies, financial policies, and privacy policies
- Performed other office tasks as needed
- Confirmed appointments with patients and verified insurance coverage
- Learned to be extremely productive in a high volume, fast pace, environment
- Verified Insurance eligibility and collected insurance copayments
- Balanced receipts out at the end of the day
- Schedule various test/procedures, specialist visits, and follow up appointments for patients
- Arrange peer-to-peer discussions between physicians and health plan administrators
- Expedite patient referrals to specialty offices, faxed medical records, answer patient and specialty office calls and completed referral requests
- Ability to work independently and unsupervised maintaining a superior work ethic
- Call insurance companies for patients to obtain precertification for podiatry visits, MRI's, CT Scans etc
- Prioritized work load and maintained an organized workspace
- Tracked prior authorizations from patient's insurance companies for things like MRI's CT Scans etc
- Trained staff on referral/authorizations intake process
- Verified, updated and corrected patient-related information including registration, insurance information, and referrals on a daily basis
- Ability to effectively communicate patient account inquiries, and resolve insurance and billing issues by utilizing all resources for account resolution
- Communicates and educates patient of referral compliance and need for upcoming scheduled service
- Validates all necessary referral and/or authorizations for scheduled services are on file and valid for schedule appointments
- Reviews and resolves insurance, referral and/or authorization issues not valid and contacts insurance carriers to verify/validate requirements to ensure accuracy and avoid potential denial and contact physician office if necessary to have referral/authorization submitted
- Answer daily inbound calls from patients and provider offices regarding insurance and referral requirements
Financial Coordinator
Finex Management/ Western Queens
02.2006 - 11.2012
- Prepare medical billing for approximately 80 patients and forward it to the main office daily
- Accurately write referrals for patients, requesting pre-certification from major insurance companies for MRIs and CT scans
- Verifies and reviews insurance coverage according to policies and procedures
- Request authorization for medical services as requested by physician for all managed care insurances
- Prepare billing in compliance with standard ICD-9 and CPT coding while following all required medical guidelines
- Performs point of service account follow-up for all patients seen in area including reviewing account balances, discussing outstanding balances and requesting payment/insurance information as appropriate
- Assists patients or guarantors in answering any questions regarding billing of services
- Performs data entry on a daily basis
Legal Assistant
Martinez Law Group PC
01.2005 - 08.2005
- Perform secretarial duties in a multi-task environment: answering phones, filing, typing, copying, emailing, and faxing
- Organize, file, and maintain client records
- Type correspondence and insert data into the computer
Education
High School Diploma -
LaGuardia Middle College H.S.
Long Island City, NY01.2002
Skills
- Epic
- Healthcare industry
- Organizational skills
- Credential verification
- Data entry
- Credentialing software- VerityStream, Cactus
- Document review
- Teamwork and collaboration
- Time management abilities
- Problem-solving
- Data verification
- Time management
- Attention to detail
- Teamwork
- Team collaboration
- Critical thinking
- Effective communication
Languages
Spanish
Native or Bilingual
Timeline
Credentials Coordinator II
Mount Sinai Queens
12.2016 - Current
Offsite Patient Coordinator
Mount Sinai Multispecialty Physicians
12.2012 - Current
Financial Coordinator
Finex Management/ Western Queens
02.2006 - 11.2012
Legal Assistant
Martinez Law Group PC
01.2005 - 08.2005
High School Diploma -
LaGuardia Middle College H.S.
Similar Profiles
CIERA D'AGUILARCIERA D'AGUILAR
Medical Assistant - Emergency Department at Mount Sinai Morningside / Mount Sinai QueensMedical Assistant - Emergency Department at Mount Sinai Morningside / Mount Sinai Queens
Kamil AhmedKamil Ahmed
RN, Emergency Department at Mount Sinai QueensRN, Emergency Department at Mount Sinai Queens
FREDDY COLLADOFREDDY COLLADO
Security/Pavilion Front Desk at Mount Sinai QueensSecurity/Pavilion Front Desk at Mount Sinai Queens
Natasha AlphonsoNatasha Alphonso
Housekeeping Cleaner at Amtrak RailroadHousekeeping Cleaner at Amtrak Railroad
Keion TullochKeion Tulloch
Customer Delivery Inspector ( CDI ) at Raymour & FlaniganCustomer Delivery Inspector ( CDI ) at Raymour & Flanigan