Reliable and highly skilled Credentialing Specialist with broad and deep knowledge of the healthcare industry. Able to function well as an independent worker, take full ownership of work, plan ahead, meet deadlines, and follow through on commitments. Focus on the positive aspects of situations and people. Handle unexpected situations and changes with a good attitude and performance. Experienced Credentialing Specialist adept at conducting application reviews and primary source verifications. Excellent relationship-building, problem-solving and communication skills. Experienced administrative professional with 15+ years in provider credentialing services. Works productively with facilities, provider groups and individual professionals. Knowledgeable about application requirements for government and private insurance plans. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Hi, I’m
Nadia Aponte
Woodland Park,NJ
Summary
Overview
22
years of professional experience
3
years of post-secondary education
Work History
New Season - Remote
Credentialing Specialist
12.2021 - Current
Job overview
- • Performed and maintained the enrollment in health insurance plans, state Medicaid entities, and Medicare for the company’s multi-state clinics.
• Ensured the accuracy and compliance of all contracting documents with company policy.
• Established and maintained working relationships with all payers through constant communication with provider representatives.
• Monitored updates and requirements for contracting for each individual plan to effectively implement rollouts to the clinics.
• Followed up and monitored all stages of the credentialing process and plan application deadlines.
• Assisted in developing good payer relations by returning all required information in a timely manner.
• Provider enrollment
• Liaised with third-party payers, field personnel, and other departments regarding authorizations, claims, payment plans, and appeals.
• Maintained a high level of accuracy and attention to detail.
• Analyzed inbound requests to determine accuracy and route requests to provider changes or other cross-functional teams.
• Maintained provider data management systems for accuracy.
• Handled and resolved provider data issues, such as mass change updates, limited reconciliations, and direct submissions of urgent requests.
• Coordinated provider data between the health plan database and various internal databases.
• Submitted daily and weekly internal and external status reports.
• Credentialed providers, hospital privileges, facilities, and ancillary services, verifying qualifications to ensure current competence to grant privileges.
• Managed multiple priorities effectively, resulting in the on-time completion of credentialing tasks for numerous providers simultaneously.
• Performed and maintained the enrollment in health insurance plans, state Medicaid entities, and Medicare for the company’s multi-state clinics.
• Ensured the accuracy and compliance of all contracting documents with company policy.
• Established and maintained working relationships with all payers through constant communication with provider representatives.
• Monitored updates and requirements for contracting for each individual plan to effectively implement rollouts to the clinics.
TAMI HCSS LLC.
Administrative Support Part Time
05.2010 - Current
Job overview
- Assisted Practice Administrator and Medical Staff Manager in various administrative and clerical duties.
- Resolved any correspondence from private and commercial insurance regarding credentialing/renew contract
- Medical Staff and Adjunct Professional Staff credentialing/privileging/reappointment process
- Maintained all medical licenses, DEA, and malpractice insurance
- Credentialing privileging reappointment activities as defined by JCAHO standards, state, and Federal regulatory agencies
- Initiated and processed provider add, change, and termination forms
- Handled credentialing for physicians, IDTF, physical therapy, psychiatry, behavior health, primary care physician, dentistry, urgent care facilities, DME, imaging centers, PECOS, provider licensing, and facility certifications.
- Increased customer service success rates by quickly resolving issues.
- Planned and coordinated logistics and materials for board meetings, committee meetings, and staff events.
- Trained and supervised employees on office policies and procedures.
- Directed automation of office procedures such as correspondence management, recordkeeping and online communications.
- Provided exceptional customer service by promptly addressing inquiries from clients, vendors, or internal staff members via phone or email correspondence.
HACKENSACK UNIVERSITY Medical Center
Clinical Data Manager, Oncology Research, Transplant Division
11.2002 - 05.2010
Job overview
- Organized and prepared for all study-related sponsor visits including, but not limited to, Pre-Site Initiation Visits, Site Initiation Visits, Routine Monitor Visits, Close-Out Visits, Internal Audits, and Sponsor Audits
- Record accurate data by completing paper or electronic CRFs
- Performed thorough review of clinical protocols to identify potential risks or inconsistencies in study design.
Education
Bethlehem UniversityJerusalem- Israel
Associate of Arts from BUISNESS MANAGMENT
09.1986 - 05.1989
University Overview
Skills
- Effective oral and written communication skills
- Maintains required level of confidentiality and uses discretion when necessary
- Interacts effectively with employees at all levels
- Credentialing oversight
- Database Maintenance
- Microsoft Office
- Data Analysis
- Applicant Qualification
- Application coordination
- Provider Relations
- HIPAA Compliance
- Provider enrollment
- Data Management
- Management Consulting
Quote
Success isn't just about what you accomplish in your life; it's about what you inspire others to do.
Timeline
Credentialing Specialist
New Season - Remote
12.2021 - Current
Administrative Support Part Time
TAMI HCSS LLC.
05.2010 - Current
Clinical Data Manager, Oncology Research, Transplant Division
HACKENSACK UNIVERSITY Medical Center
11.2002 - 05.2010
Bethlehem University
Associate of Arts from BUISNESS MANAGMENT
09.1986 - 05.1989
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