Phyllis Quirino
Las Vegas,NV
Summary
To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills. Experienced Credentialing Specialist adept at conducting application reviews and primary source verifications. Excellent relationship-building, problem-solving and communication skills. Achievements include completing more than 15 healthcare provider applications each month with no critical errors. Highly organized and detail-oriented with in-depth knowledge of insurance regulations. Works productively with facilities, provider groups and individual professionals. Knowledgeable about application requirements for government and private insurance plans. Hardworking and passionate job seeker with strong organizational skills eager to secure senior-level Credentialing Representative position. Ready to help team achieve company goals.
Overview
23
23
years of professional experience
1
1
Credentialing Certificate
1
1
Medical Billing Certificate
Work History
Certified Credentialing Specialist
LGTC Group
09.2021 - Current
- Conducted primary source verifications such as background checks and board certifications.
- Managed 125 CAQH accounts, re-attesting in timely manner, ensuring all DEA, licensure, locations, PLI's are current.
- Obtained NPI numbers for providers and facilities and updated existing profiles.
- Received and evaluated applications to look for missing and inaccurate information.
- Collected and analyzed information to monitor compliance outcomes and identify and address trends of non-compliant behavior.
- Improved organizational filing systems for confidential employee records, resulting in improved accessibility and efficiency.
- Advocated for staff members, helping to identify and resolve conflicts.
- Prepared records for site visits and file audits.
- Coordinated implementation of people-related services, policies and programs through departmental staff.
- Enrolled providers and Medicaid, Medicare and private insurance plans.
- Developed and implemented onboarding and orientation programs for new employees.
Certified Medical Billing Specialist
Sole Proprietorship
03.2014 - 12.2021
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Located errors and promptly refiled rejected claims.
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Identified and resolved patient billing and payment issues.
- Researched CPT and ICD-10 coding discrepancies for compliance and reimbursement accuracy.
- Collected payments and applied to patient accounts.
- Posted and adjusted payments from insurance companies.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Precisely evaluated and verified benefits and eligibility.
- Precisely completed appropriate claims paperwork, documentation and system entry.
- Filed and updated patient information and medical records.
- Prepared billing correspondence and maintained database to organize billing information.
- Communicated effectively and extensively with other departments to resolve claims issues.
- Liaised between patients, insurance companies, and billing office.
Medical Billing & Coding Specialist
Cypress Healthcare Partners
06.2016 - 02.2019
- Prepared billing statements for patients and verified correct diagnostic coding.
- Verified insurance of patients to determine eligibility.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Delivered timely and accurate charge submissions.
- Reviewed patient records, identified medical codes, and created invoices for billing purposes.
- Collaborated with customers to resolve disputes.
- Audited and corrected billing and posting documents for accuracy.
- Used data entry skills to accurately document and input statements.
- Processed payment via telephone and in person with focus on accuracy and efficiency.
Assistant Office Manager
Northern California Retina Vitreous Associates
06.2000 - 03.2015
- Kept front office clean and well-organized to keep areas presentable for guests and maximize professional appeal.
- Created and updated physical records and digital files to maintain current, accurate, and compliant documentation.
- Transferred and directed phone calls, guests, and mail to correct staff members.
- Oversaw office inventory activities by ordering and requisitions and stocking and shipment receiving.
- Managed accurate and fully compliant AP/AR operations by documenting expenses, reconciling accounts and correcting discrepancies.
- Conferred with insurance company representatives to expedite payments and resolve filing issues, keeping aging balances low and office finances strong.
- Conducted research to assist with routine tasks and special projects.
- Recorded and tracked operational expenses to identify and eliminate wasteful spending.
- Drafted agendas, recorded minutes and generated documents to facilitate meetings.
- Delivered performance reviews, recommending additional training or advancements.
- Coordinated board and committee meetings, schedules, information preparation and distribution.
- Offered technical support and troubleshot issues to enhance office productivity.
- Created and updated records and files to maintain document compliance.
- Delivered top-notch administrative support to office staff, promoting excellence in office operations.
- Sorted, opened, and routed mail and deliveries to meet business requirements.
Education
High School Diploma -
Yerba Buena High School
San Jose, CA06.1983
Skills
- Problem Resolution
- Analytical and Critical Thinking
- Credential Verification
- Confidential Records Management
- Insurance Credentialing Processes
- Facility Credentialing
- Credentialing Requirements
- Complaint Handling
- Adaptable to Changing Conditions
- Credentialing Policies
- Provider Enrollment
- Business Correspondence
- Credentialing Documentation
- Provider Relations
- Remote Conferencing and Communication
Certification
- Certified Credentialing Specialist AAPC - 2023
- Certified Medical Billing Specialist, ABS, LLC - 2008
Timeline
Certified Credentialing Specialist
LGTC Group
09.2021 - Current
Medical Billing & Coding Specialist
Cypress Healthcare Partners
06.2016 - 02.2019
Certified Medical Billing Specialist
Sole Proprietorship
03.2014 - 12.2021
Assistant Office Manager
Northern California Retina Vitreous Associates
06.2000 - 03.2015
High School Diploma -
Yerba Buena High School
- Certified Credentialing Specialist AAPC - 2023
- Certified Medical Billing Specialist, ABS, LLC - 2008
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