Martha De Paula Arias

• Managed daily operations for optimal performance, ensuring smooth workflows and timely completion of tasks.
• Maintained open lines of communication with upper management to provide regular updates on operational progress and challenges faced by the team.
• Conducted regular performance evaluations for direct reports, identifying areas for improvement and setting development goals accordingly.
• Enhanced team productivity by providing ongoing training, coaching, and mentoring to staff members.
• Reduced employee turnover by fostering a positive work environment and addressing employee concerns promptly.
• Implemented quality control systems to reduce errors, resulting in increased customer satisfaction rates.

For Medicare Part B Contractor, CGS Administrators in Nashville TN. MAC with Ohio and Kentucky.

Close supervision and constant follow up with provider for pending information for CMS application status

Extremely knowledgeable of processing and procedures necessary to get an applicant approved for Medicare in a timely manner.

Worked with the following programs: PMDB, Pecos, Ab/Mac, Onbase, Unity and Onbase Web.

Enroll Physicians, Non physicians, Sole Owners, Sole Proprietor and all types of group applications Work efficiently with a team to ensure timelines standards are met.

Credentialed with CMS forms 855I, 855S, 855B, 855R, EFT, PAR Agreement.

• Enhanced accuracy in provider data submission by conducting regular audits and identifying areas for improvement.

• Prepared records for site visits and file audits.
• Pharmacy Mail Order and Retail credentialing in all 50 States.
• Pharmacy contracting for CVS, Express Scripts and Optum RX, etc.
• Enrolled providers and Medicaid, Medicare and all government insurances.
• Received and evaluated applications to look for missing and inaccurate information.
• Obtained NPI numbers for providers and facilities and updated existing profiles.
• Provider credentialing for all commercial insurances.
• AHCA Certification in the state of Florida.

• Assisted in opening new practice for a Nurse Practitioner
• Office Manager, Check-in and Check-out, referrals, scheduling patients
• Credentialing and Contracting Medicare, Medicaid and all commercial insurance including AHCA Certification.

• Assist medical professionals with patient management, basic diagnostic tests, and recordkeeping
• Check in, check out, collections and referrals
• Work at clinics, outpatient programs, or other medical facilities, ensuring a pleasant experience and a high level of care.

• Accompanied physician during patient consultations and assisted in recording patient history and physical exam findings into the electronic medical records
• (e-clinical) Program
• Organize and transcribed results for patient’s laboratory tests, medications and imaging studies
• Document procedures completed and recorded diagnostic test results
• Document all diagnoses, treatment plans, prescriptions and discharge and follow up information and all the above mentioned with e-clinical works V 11(EHR)., Enroll provider enrollment applications for Medicare Part B providers

• Experience in monitoring, apply and renew licenses for Pharmacy, RT, Pharmacist, DME, Oxygen, FDA, operations for compliance with federal and state regulations and standards
• Acquire local, state and count licenses
• Experience in contracts (PBM) Pharmacy Benefit Management (CVS, Optum, Express Scripts (Part D)
• Project Management
• Policies and procedures adhere to existing regulations
• Experience in foreign and Corporate filings and renewals
• Acquiring and renewing Surety Bonds
• Experience in Medicare and Commercial Audits
• Successfully led key projects which resulted in receiving High Five Award.

• For Medicare Part B Contractor, CGS Administrators in Nashville TN, Ohio and Kentucky and for Medicare Part B Contractor Cahaba, credentialing for Alabama, Georgia and Tennessee
• Close supervision and constant follow up with provider for pending information for CMS application status
• Notable Accomplishments: Keep over 98% productivity rate and accuracy on a weekly basis
• Received high recommendations from providers (Medicare) on my excellent customer services skills
• Extremely knowledgeable of processing and procedures necessary to get an applicant approved for Medicare in a timely manner
• Recognized as a team lead in the Revalidation project for Medicare at CGS Administrators
• Worked with the following programs: PMDB, Pecos, Ab/Mac, Onbase Unity and Onbase Web.
• Enroll Physicians, Non physicians, Sole Owners, Sole Proprietor and all types of group applications Work efficiently with a team to ensure timelines standards are met
• Credentialed with CMS forms 855I, 855S, 855B, 855R, EFT, PAR Agreement.

Collect all credentials from physicians to prepare all insurance applications

• Assigning benefits to the group providers for Medicare, Medicaid and BCBS of Florida
• Apply for county and city licenses
• Credentialed for Baptist Hospital, South Miami Hospital and Larkin Hospital
• Prepare revenue reports for HMO's and PPO's
• Negotiate with insurance contracts for higher reimbursements
• Notable Accomplishments: Assisted the Pathology Group of NW Florida based in Pensacola, FL obtain approvals for Clinical Laboratory Improvement Amendment Certificates (CLIA License)
• Credentialed Medigo Urgent Care in Miami for business under the Florida Agency for Health Care Administration (AHCA)
• Contributed with the reinstatements of doctors with issues regarding their Medicare provider numbers and medical licenses
• Responsible for the approvals of all the major medical insurance companies for Baptist Urgent Care in Miami including Medicare, Medicaid, Champus and Blue Cross & Blue Shield of Florida
• Assisted over seventy doctors on staff obtain their credential.