Karla Tamez
Hemet,CA
Summary
Detail-oriented and results-driven Out of State provider enrollment specialist with experience managing provider enrollment, credentialing, and revalidation for Medicaid. Exceptional organizational skills, and the ability to manage multiple priorities in fast-paced healthcare environments.
Overview
20
20
years of professional experience
Work History
Enrollment Specialist
Parallon
08.2020 - Current
- Complete and submit provider enrollment, revalidation, and credentialing applications for multiple state Medicaid.
- Developed and maintained relationships with prospective students to facilitate smooth onboarding experiences.
- Coordinate with providers, credentialing teams, and payer representatives to obtain required documentation.
- Managed enrollment processes to ensure compliance with regulatory standards and organizational policies.
- Trained new team members on enrollment procedures and best practices to enhance operational efficiency.
- Assist with audits and resolve-related billing issues.
- Track enrollment deadlines, expirations and revalidation schedules.
Patient Support Representative
Parallon-Riverside Community Hospital
02.2016 - 07.2020
- Assisted multiple hospitals in creating revenue by screening uninsured patients and Medicare patients for secondary coverage. Aided in qualifying them for governmental assistance programs and ascertained other state/county programs.
- Completed application packet and authorizations, obtained documents, worked the package at bed-side while patient remained in-house.
- Followed up on and processed files for submission, decision, and bill tracking to ensure timely resolution of patient applications.
- Performed data entry for patient case files to maintain accurate records.
- Knowledge of programs such as Medicare, Medi-Cal, Secondary for Long Term Care
- Processed approvals and cancellations for California Children’s Services (CCS) accounts
- Prepared daily, weekly and monthly reports for the hospital
- Home visitation of patients after hospital discharge to obtain proper verifications to ensure Medi-Cal account approvals
- Collaborated with hospital departments including admitting/registration, case management, denial prevention, and finance to ensure timely submission and processing of all applicant documentation and appeal requests.
- Performed administrative duties, including reports, emails, and phone calls.
Insurance Agent
Control Insurance Services
10.2015 - 01.2016
- Developed sales opportunities for property, casualty, health, and life insurance policies, contributing to overall agency growth.
- Developed sales opportunities on property and casualty insurance policies as well as health and life insurance policies.
- Assisted customers with Health insurance and with Long-Term care insurance policies that will cover the costs of medical care and assisted-living services in old age.
- Managed a book of business of over 1000 insurance customers by providing coverage recommendations and suggesting policy changes.
- Established clientele through networking efforts, expanding customer base and enhancing agency visibility.
- Monitored policy renewals and cancellations, providing convenient solutions to improve customer retention for the agency.
- Resolve complex conflicts and identify resources for problem resolution and design best-option solutions
- Develop and promote positive customer relationships while handling requests for assistance by phone or email
- Managed Finance companies inquiries by reviewing and verifying insurance coverage for mutual customers
Operations/Office Administrator
Trinity Truck and Fleet Repair
01.2012 - 10.2015
- Supervise and track jobs making sure they are done within specified deadline
- Managed collections process by organizing and tracking payments, billing, payroll and correspondence
- Maintained close communications with key customers, oversee that all projects run smoothly
- Prompt response to all customer inquiries by providing effective and efficient customer service to verbal and written inquiries
- Resolving client concerns and complaints while ensuring that Service Excellence Standards are met
- Prepare budgets and monitor actual expenditures, dispatch personnel
- Maintained close communication with key customers and ensured all projects ran smoothly
- Responded promptly to customer inquiries, delivering effective and efficient service for verbal and written requests
- Reviewing and approving supply requisitions
Insurance Agent/Customer Service
Martplan Insurance Agency
08.2010 - 01.2012
- Increased Commercial accounts by 30% by developing marketing strategies for the Agency
- Managed policyholder and commercial accounts to ensure client satisfaction and retention
- Operated insurance software to develop top financial policy option for clients
- Grew commercial accounts by 30% through effective marketing strategies
- Responded to incoming policyholder calls, addressing inquiries, resolving issues, and correcting policy errors
- Resolved customer complaints effectively, conflicts and challenging situations
Office Administrator
Anaheim Insurance Services
01.2007 - 08.2010
- Trained new personnel to enhance team efficiency and ensure smooth onboarding
- Determine charges for services requested, collect deposits or payments, and/or arrange for billing
- Maintained communications with key staff to ensure productivity
- Maintained communication with key staff to support project continuity and team alignment
- Managed office commercial accounts with coverage in excess of 1 million dollar.
- Oversaw commercial accounts for the office, ensuring proper management and service delivery. with coverage in excess of 1 million dollars.
- Developed and maintained a client base, answered questions and concerns and explained best discount options
Education
Bachelor of Science - Business Administration, International Business, Entrepreneurship Small Business Management
California State Polytechnic University
Pomona12-2014
Skills
- Bilingual communication
- Microsoft Office Suite
- Exceptional communication
- Reporting and analytics
- Documentation management
- Medicaid enrollment
- Effective organizational skills and time management
- Organizational skills
Timeline
Enrollment Specialist
Parallon
08.2020 - Current
Patient Support Representative
Parallon-Riverside Community Hospital
02.2016 - 07.2020
Insurance Agent
Control Insurance Services
10.2015 - 01.2016
Operations/Office Administrator
Trinity Truck and Fleet Repair
01.2012 - 10.2015
Insurance Agent/Customer Service
Martplan Insurance Agency
08.2010 - 01.2012
Office Administrator
Anaheim Insurance Services
01.2007 - 08.2010
Bachelor of Science - Business Administration, International Business, Entrepreneurship Small Business Management
California State Polytechnic University