Josue Ortiz Balay
Orlando
Summary
Proven Credentialing Specialist with expertise in credential verification, compliance monitoring, and database management. Committed to streamlining processes and ensuring timely completion of credentialing tasks.
Overview
6
6
years of professional experience
Work History
Credentialing Specialist II
Loyal Source Government Services, LLC
Orlando
03.2021 - Current
- Review and verify credentials of healthcare professionals for compliance.
- Coordinate documentation collection from applicants and stakeholders efficiently.
- Maintain accurate databases of provider credentials and licensure status.
- Communicate with applicants to clarify credentialing requirements and processes.
- Monitor renewal dates for licenses and certifications to ensure compliance.
- Collaborate with team members to streamline credentialing workflows effectively.
- Conduct background checks to confirm applicant qualifications and history.
- Ensure timely completion of credentialing processes by providing guidance to providers on required documentation.
- Perform primary source verifications such as criminal histories, licenses and board certifications.
- Process re-credentialing applications for existing providers according to contractual requirements.
- Prepare correspondence for various departments concerning credentialing updates or requests for additional information.
- Conduct background checks on potential providers utilizing various resources including state licensing boards, OIG and GSA Exclusion List, NPDB.
- Provide support in responding to inquiries from external parties regarding credentialing information.
- Maintain informational resources, tracking and documenting requests for updates, certification and credentialing.
- Participate in periodic audits of credentialing files to maintain compliance with applicable regulations and policies.
- Maintain detailed records of provider data in the credentialing database system.
- Process documents and status-change requests, conducting followup assessment regarding enrollment inquiries.
- Monitor expiration of licenses and certifications, notifying providers of renewal requirements.
Customer Service Representative
Procare Medical
Orlando
10.2020 - 03.2021
- Assisted patients in transitioning from bedside or home to wheelchairs or gurneys, ensuring safe transfer into specialized vehicles for medical transport.
- Specialized Vehicle Operation: Driving and maintaining vehicles equipped with medical ramps, lifts, and securement systems for mobility devices.
- Conducted initial patient assessments and monitored conditions during transit to enhance comfort and ensure stability.
- Coordinated with dispatchers, hospital staff, and families to align pickup and drop-off times with medical appointments for seamless service delivery.
- Regulatory Documentation: Maintaining meticulous trip logs, vehicle inspection reports, and billing documentation to comply with Medicaid or private insurance standards.
Information Technology Specialist
Spectrum
Orlando
10.2019 - 09.2020
- Functioned as customer support agent and technical troubleshooter, resolving issues to enhance user satisfaction.
- Ensured seamless digital experience for customers by focusing on internet connectivity and online service reliability.
- Service Optimization: Using diagnostic tools to analyze internet speeds and recommending upgrades or hardware changes to improve the customer's high-speed service.
- Addressed inquiries on internet service charges, processed payments, and clarified promotional offers to support customer understanding.
Education
Associate of Science - Mortuary Science
Antilles School of Technical Careers
San Juan, PR05-1996
Skills
- Credential verification
- Primary source verification
- Documentation management
- Compliance monitoring
- Attention to detail
- Time management
- Critical thinking
- Problem solving
- Customer service
Timeline
Credentialing Specialist II
Loyal Source Government Services, LLC
03.2021 - Current
Customer Service Representative
Procare Medical
10.2020 - 03.2021
Information Technology Specialist
Spectrum
10.2019 - 09.2020
Associate of Science - Mortuary Science
Antilles School of Technical Careers