Patrick Castro
Bergenfield,New Jersey
Summary
Detail-oriented healthcare professional with strong experience in provider enrollment, credentialing, and insurance verification. Skilled at reviewing and interpreting clinical documentation, such as diagnoses, treatment plans, and medical necessity, that guide authorization decisions. Gained broad knowledge of clinical workflows across multiple specialties, and familiarity with medical terminology and procedures. Known for maintaining regulatory compliance, improving workflows, and working well with diverse teams. Seeking to apply this clinical expertise and operational experience in a Clinical Research Coordinator role, focused on accuracy and patient care.
Overview
11
11
years of professional experience
Work History
Provider Enrollment & Credentialing Coordinator
Columbia University in the City of New York
Fort Lee, NJ
07.2024 - Current
- Manage the full lifecycle of provider credentialing and payer enrollment for over 70 clinicians, ensuring accuracy across institutional databases to support compliance with billing protocols.
- Collaborate with revenue cycle staff and clinical departments to align provider credentialing timelines with operational needs, enabling smooth onboarding.
- Maintain meticulous digital and paper documentation for audits, surveys, and regulatory reviews in accordance with institutional guidelines.
- Interpret payer and regulatory correspondence to resolve credentialing discrepancies, improving accuracy in provider records used for billing and enrollment logs.
- Develop and update standard operating procedures (SOPs) related to credentialing workflows, enhancing data quality, and documentation consistency across departments.
- Prepare weekly credentialing status reports and dashboards that assist leadership in tracking key performance indicators relevant to start-up timelines.
- Support education and onboarding for new staff by training team members on documentation, data entry, and credentialing systems related to compliance.
- Perform other duties and projects as assigned to support department objectives, and special initiatives.
Authorization Referral Specialist II
61st Street Corporation
Fort Lee, New Jersey
02.2021 - 07.2024
- Verified provider participation and patient eligibility using NPI, Tax ID, and provider IDs, ensuring all authorization requests aligned with clinical documentation and payer requirements.
- Reviewed and interpreted clinical notes, imaging reports, and physician orders to determine medical necessity, and appropriate authorization pathways for services.
- Coordinated and obtained pre-authorizations and referrals by applying clinical knowledge to assess the validity and urgency of requests, supporting efficient patient care decisions.
- Monitored and followed up on outstanding authorizations, using clinical criteria to prioritize cases, and escalate urgent matters appropriately.
- Audited referral and authorization documentation against clinical records, identifying missing or inconsistent information, and working with providers to ensure completeness and accuracy.
- Maintained detailed, audit-ready records of all authorizations, demonstrating strict adherence to clinical guidelines, and payer protocols.
- Communicated effectively with providers, insurance companies, and patients, using clinical understanding to explain requirements, resolve discrepancies, and facilitate timely approvals.
- Supported special projects that required analyzing clinical workflows and documentation processes, contributing to improvements in authorization efficiency and accuracy.
Authorization Referral Specialist I
61st Street Corporation
Fort Lee, New Jersey
02.2020 - 02.2021
- Assisted patients with referral processes, clarifying clinical and administrative requirements.
- Reviewed clinical documentation to verify eligibility and obtain prior authorizations.
- Used checklists to identify and escalate incomplete data, ensuring timely approvals.
- Tracked referrals and resolved delays by coordinating with providers and payers.
- Maintained accurate patient and clinical data in compliance with HIPAA and billing policies.
- Supported authorization by assessing medical necessity, and coordinating with clinical teams.
Insurance Verification Specialist Level I
61st Street Corporation
Fort Lee, New Jersey
08.2019 - 02.2020
- Verified patient insurance coverage and eligibility to support clinical service scheduling.
- Communicated with insurance carriers, patients, and third parties to clarify benefits and resolve coverage issues.
- Accessed and analyzed insurance databases for accurate coverage verification.
- Applied medical terminology knowledge to interpret procedure codes and insurance policies.
- Assisted with additional duties as assigned, demonstrating flexibility and teamwork.
Courier
FedEx
Moonachie, NJ
08.2018 - 08.2019
- Maintained detailed delivery records, including recipient signatures and timestamps, for proof of delivery.
- Delivered clinical specimens and sensitive materials, ensuring secure handling and timely, accurate delivery.
- Planned and optimized delivery routes to consistently meet tight deadlines, and improve efficiency.
- Adhered to all safety regulations and transportation laws, minimizing risk, and ensuring compliance.
- Sorted, loaded, and delivered packages with strong attention to detail and accuracy.
Bank Teller
NVE Bank
Cresskill, NJ
11.2015 - 08.2018
- Processed daily transactions with accuracy and compliance to banking regulations.
- Built strong client relationships, remembering 40+ regular customers, to enhance the service experience.
- Adhered to privacy and fraud prevention protocols, ensuring regulatory compliance.
- Resolved customer issues efficiently, demonstrating adaptability, and problem-solving skills.
- Operated banking software to manage accounts, loan payments, safe deposit boxes, and cash handling.
- Balanced cash drawers and corrected discrepancies to maintain financial accuracy.
Store Manager
MetroPCS Corporate Store
Bergenfield, NJ
05.2014 - 10.2015
- Led and motivated a team of sales associates, providing training and support to achieve sales targets, and deliver excellent customer service.
- Built and maintained strong vendor relationships to enhance product offerings and service quality.
- Managed inventory, sales, and financial records, using data analysis to inform business decisions, and optimize store performance.
- Addressed operational challenges such as technical issues, staffing gaps, and inventory discrepancies, with effective problem-solving.
- Oversaw store opening and closing procedures, including cash handling, and staff scheduling.
- Delivered personalized product knowledge and prioritized customer satisfaction with a sense of urgency.
Education
Aircraft Operations -
Bergen Community College
Technical Support Fundamentals -
Google Coursera
01.2021
High School Diploma -
Bergenfield High School
01.2013
Skills
- Microsoft Office/Excel/Access
- Clinical Terminology & Research Processes
- HIPAA Compliance
- PEG
- Leadership Skills
- Adaptability
- Time Management
- Customer Service
- Epic Systems
- Problem-Solving
- Negotiation and Resolution
- Conflict Resolution
- Proactive and forward-thinking approach
- Collaborative Nature
- Excelling in building connections with various teams
Languages
- English Native speaker
- Spanish Native speaker
Volunteer Experience
- Englewood Saint Cecilia Church Food Bank
- Teterboro Airport - Bergen Community College
References
References available upon request
Timeline
Provider Enrollment & Credentialing Coordinator
Columbia University in the City of New York
07.2024 - Current
Authorization Referral Specialist II
61st Street Corporation
02.2021 - 07.2024
Authorization Referral Specialist I
61st Street Corporation
02.2020 - 02.2021
Insurance Verification Specialist Level I
61st Street Corporation
08.2019 - 02.2020
Courier
FedEx
08.2018 - 08.2019
Bank Teller
NVE Bank
11.2015 - 08.2018
Store Manager
MetroPCS Corporate Store
05.2014 - 10.2015
Aircraft Operations -
Bergen Community College
Technical Support Fundamentals -
Google Coursera
High School Diploma -
Bergenfield High School
Similar Profiles
DAMIEN NOLANDAMIEN NOLAN
Catering Operations Manager at Columbia University City of New YorkCatering Operations Manager at Columbia University City of New York
Leonor SuarezLeonor Suarez
Patient Financial Advisor at New York Presbyterian Hospital Columbia UniversityPatient Financial Advisor at New York Presbyterian Hospital Columbia University
Miosotys NuñezMiosotys Nuñez
Nuclear Medicine Program Coordinator at New York Presbyterian Hospital/ Columbia UniversityNuclear Medicine Program Coordinator at New York Presbyterian Hospital/ Columbia University
JOHEIri ACEVEDOJOHEIri ACEVEDO
Insurance Verification Specialist at Comprehensive Mri of New YorkInsurance Verification Specialist at Comprehensive Mri of New York
Astrit KupiAstrit Kupi
Server Assistant at Monkey BarServer Assistant at Monkey Bar