Juana P Cetina

• Ensured timely completion of credentialing processes by providing guidance to providers on required documentation.
• Reviewed and processed credentialing applications to ensure accuracy, completeness, and compliance with all accreditation standards.
• Processed re-credentialing applications for existing providers according to contractual requirements.
• Prepared correspondence for various departments concerning credentialing updates or requests for additional information.
• Provided support in responding to inquiries from external parties regarding credentialing information.
• Maintained informational resources, tracking and documenting requests for updates, certification and credentialing.
• Checked applications for missing information and organized all paperwork.

• Processed medical claims using electronic billing systems efficiently.
• Reviewed patient records for accurate coding and documentation compliance.
• Collaborated with healthcare providers to resolve billing discrepancies promptly.
• Maintained up-to-date knowledge of coding guidelines and payer regulations.
• Communicated with insurance companies regarding claim status and appeals directly.
• Implemented best practices for improving billing workflows within the department.
• Verified accuracy of patient information and insurance data in billing system.

• Maintained informational resources, tracking and documenting requests for updates, certification, and credentialing.
• Checked applications for missing information and organized all paperwork.
• Maintained practitioner information in electronic format.
• Completed online and paper documents for insurance companies.
• Maintained CAQH profiles.
• Monitored expiring documents.
• Maintained informational resources, tracking and documenting requests for updates, certification and credentialing.
• Performed primary source verifications such as criminal histories, licenses and board certifications.

• Scheduled patients according to availability, urgency, and insurance authorization guidelines.
• I managed up to 60 patient referrals daily through the multi-line telephone system.
• Verified documents and associated records to catch and resolve discrepancies.
• I developed productive working relationships with numerous insurance company representatives.
• Reviewed referral details and expectations with providers and patients and requested new referrals when necessary.

Coordinated all department functions for a team of five employees. Maintained detailed administrative and procedural processes to improve accuracy and efficiency.

• Oversee all Accounts Payable, including itemizing bills, reviewing and monitoring expenses, and making payments in a timely fashion.
• Ascertain that all receipts, payments, and Practice Monies are handled using generally accepted accounting procedures. Confirm that audit trails are in place.
• Oversee all Accounts Receivable functions, including filing insurance claims, patient statements, insurance, and patient payment follow-up, collection processes, compliance with standard billing practices, and Medicare and Medicaid rules.
• I reviewed all reports for accuracy and trends to present the Practice's financial position to the doctors.
• Approved all employee hours, reviewed for accuracy, and made adjustments as necessary. Maintained all employee time and attendance records.
• Maintained office, physicians' liability, and other insurance, certificates, and licenses active to include organization of all official documents.