Rachel J. Zavala

• Manage provider credentialing and re-credentialing processes, ensuring licensure, certifications, and malpractice coverage remain current and compliant with regulatory standards.
• Conduct audits, maintain confidential provider records, and ensure all credentialing activities follow hospital bylaws, supporting accreditation readiness and HIPAA compliance.
• Track mandatory licensure renewals for all medical personnel, maintaining 100% compliance and uninterrupted provider privileges.
• Attend credentialing committee meetings, provide leadership with new reappointment lists, and document issues or waivers requiring discussion or follow-up.
• Coordinate and create provider schedules across multiple department groups, posting finalized schedules hospital-wide to ensure seamless coverage.
• Verify provider schedules to ensure accurate call pay for all shifts, supporting timely and correct compensation for employed and outsourced providers.

• Addressed patient concerns promptly and professionally, demonstrating empathy and excellent problem-solving skills.
• Managed daily practice operations to optimize appointment scheduling, patient records management and billing functions.
• Ordered all office supplies and kept check on inventory levels.
• Facilitated communication between staff members, fostering a collaborative work environment that improved overall team performance.
• Evaluated practice workflows regularly to identify areas for improvement and implement necessary changes efficiently.
• Oversaw the hiring process for new employees, selecting candidates who aligned with the practice''s mission and values.
• Improved operational workflows, which allowed for increase in number of daily patient appointments.
• Improved patient flow through office by redesigning check-in and check-out processes.
• Implemented new electronic health record system to improve record accuracy and accessibility.
• Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to employees.
• Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.
• Served as a resource for departmental staff by maintaining a thorough understanding of current trends and best practices in the credentialing field.
• Assisted with special projects as needed, demonstrating adaptability and commitment to the success of the organization.
• Tracked expiration dates on documents and communicated with appropriate staff to avoid late filing.
• Strengthened relationships with external agencies by responding promptly to verification requests and inquiries regarding providers'' credentials.
• Upheld strict confidentiality standards, safeguarding sensitive provider information from unauthorized access or disclosure.

• Oversaw day-to-day business operations by fostering deep professional relationships with law firms staff and customers.
• Reviewed company's strategic plans and developed departmental goals and standards to support vision.
• Worked in tandem with peers to better understand business process and initiate improvements, helping company achieve goals.
• Promoted energetic atmosphere with purpose to drive improvements in customer care and experiences.
• Recruited, hired, mentored and trained staff on business procedures, policies, duties and customer care methods.
• Listened to staff and customer issues and conflicts to deliver solutions, propel customer experiences.
• Scheduled employees for shifts, taking into account customer traffic and employee strengths.
• Tracked employee attendance and punctuality, addressing repeat problems quickly to prevent long-term habits.
• Implemented business strategies, increasing revenue and effectively targeting new markets.
• Reduced financial inconsistencies while assessing and verifying billing invoices and expense reports.
• Reported issues to higher management with great detail.
• Followed up with patients to reschedule missed appointments.
• Maintained confidentiality of patient information to comply with HIPAA regulations and protect patient privacy.

• Customer Service Support with internal and/or external affiliates/vendor's as needed to manage expectations and/or patient and family members satisfaction.
• Credentialing support with HTPN, BSWH and/or External Medical staff services to ensure completed credentialing packets are received by credentialing department(s) for timely processing.
• Acting liaison between Medical Staff office and other departments.
• Organizing and maintaining credential files and performs filing, scanning, and faxes.
• Networks and coordinates sharing, receipt, and/or update of information among various internal departments.
• Assist completion of initial and re-credentialing applications from providers
• Work with other hospital personnel to ensure that physician's practice within scope of their privileges.
• Revenue cycle support through accurately and efficiently locating patient demographic and insurance information to complete account registration in EPIC. Verifying all charges are captured and submitted by physician(s) through Medimobile and all charges utilizing proper E/M, CPT, and ICD10 codes for hospital charges or any outside activity provider has been approved for.
• Accounts Receivable support thru charge capture batch balancing, EPIC work reviews and corrections, CPT corrections per coding guidelines, appeal request processing per payor guidelines.

• Supply chain support thru vendor account setup as permitted by BSWH policies. Ordering of office supplies, computers, physician lab coats and stethoscopes as needed.

• Accounts Payable support thru invoice accuracy review and submission utilizing ImageNow. Resolve AP processing delays thru research, reprocessing if needed and updating vendors of outcomes.

• Communicated with insurance companies to research and resolved coding discrepancies.
• Performed on-site coding audits to determine accuracy and compliance with coding guidelines.
• Communicated effectively with staff, patients, and insurance companies by email and telephone.
• Correctly coded and billed medical claims.
• Interacted with physicians and other healthcare staff to ask questions regarding patient services.
• Processed insurance company denials by auditing patient files, researching procedures, and diagnostic codes to determine proper reimbursement.

• Collaborated with multiple business partners to meet business goals.
• Liaison between customers and collections department to provide payment resolutions.
• Payment posting quality control through researching and correcting, misapplied payments.
• Credit posting quality control thru reapplying credit or refunding funds on accounts.
• Responded to inquiries for information from internal teammates and external requestors.
• Conducted analysis and research on assigned projects, liaising with senior management to report findings and project status.
• Maintained records containing confidential, sensitive and vital organizational information.
• Performed research to collect and record data.
• Delivered schedule management and internal and external meeting organization