Rocio Guillen
Foothill Ranch,USA
Summary
Experienced with coordinating administrative tasks and maintaining organized office environments. Utilizes strong organizational skills to enhance office efficiency and support team operations. Track record of effective communication and multitasking to meet diverse administrative needs.
Analyst in adept in license verifications and provider enrollment, showcasing exceptional problem-solving aptitude. NCQA, URAC, CMS, PAVE, and knowledge of CAQH due to CVO prior employment and Regulations. Compliance initiatives, enhancing workflow efficiency by implementing strategic improvements. I collaborated effectively with medical staff, ensuring seamless credentialing processes and maintaining rigorous standards.
Overview
14
14
years of professional experience
Work History
Administrative Assistant
LA Care
04.2025 - Current
- Promoted a positive work environment through effective communication skills and fostering professional relationships among colleagues.
- Streamlined invoice processing procedures to ensure timely payment of vendors while minimizing errors in financial records.
- Facilitated collaboration within team by organizing regular meetings and tracking project progress.
- Boosted team productivity by managing communication channels and ensuring timely responses to inquiries.
- Managed expense reports for executive staff members, ensuring accurate documentation of spending for budgeting purposes.
- Enhanced communication within office, establishing weekly newsletter summarizing key updates and achievements.
- Developed filing system for historical documents, preserving important company records and improving access to information.
- Conducted research for project proposals, compiling information that supported winning bids.
- Managed scheduling for executive team, balancing complex calendars to ensure optimal use of time.
- Supported recruitment processes, scheduling interviews and communicating with applicants to improve hiring timelines.
- Facilitated cross-departmental communication, organizing meetings to discuss project progress and align objectives.
- Optimized calendar management for executives by scheduling appointments strategically while considering priorities and minimizing conflicts.
- Collaborated on special projects as assigned by leadership, contributing research findings or coordinating event logistics as needed for success.
Administrative Assistant
Ensign
08.2024 - 04.2025
- Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors.
- Maintained confidentiality of sensitive information by adhering to strict privacy policies and implementing secure filing systems.
- Delivered excellent customer service through prompt responses to client inquiries, addressing concerns effectively, and building strong relationships.
- Ensured accurate record-keeping with diligent data entry and database management for vital company information.
- Improved document organization with thorough file maintenance, archiving outdated records as necessary for efficient retrieval when needed.
- Supported executive staff through scheduling meetings, coordinating travel arrangements, and preparing crucial documents.
- Assisted with human resources tasks such as updating employee files or submitting time-off requests per company policy guidelines.
- Assisted in onboarding new employees, providing training materials, and coordinating orientation schedules to ensure a smooth integration into the team.
- Organized office events such as holiday parties or team-building activities, promoting a positive company culture and boosting employee morale.
Credentialing Specialist
CalOptima
11.2022 - 07.2024
- Conducted primary source verifications of education, training, licensure, and malpractice history.
- Served as liaison between healthcare providers and payer organizations during enrollment or contracting negotiations.
- Prepared and provided information for internal and external customers as appropriate.
- Reviewed provider documents to promote compliance with quality and regulatory standards.
- Updated provider database documents and profiles according to preset schedules.
- Collaborated with medical staff leadership in review and approval process for privileges requests.
- Processed reappointment applications within required timeframes to ensure continuous provider participation with health plans.
- Assisted with ongoing compliance initiatives by conducting periodic audits of practitioner files or processes related to credentialing activities.
- Implemented improvements in credential processing workflows based on department performance metrics analysis.
- Responded promptly to inquiries from payers, regulatory agencies, and internal departments regarding provider status or credentials-related issues.
- Maintained accurate electronic credentialing files for each practitioner.
- Ensured adherence to HIPAA privacy regulations while handling sensitive personal information about practitioners.
- Maintained internal provider grid to promote accurate information and available logins.
- Analyzed and resolved information discrepancies, idiosyncrasies and gaps.
- Facilitated communication among practitioners, practice administrators, medical staff leaderships on matters pertaining to credentialing policies or procedures.
Credentialing Analyst
Verifpoint
01.2012 - 10.2022
- Participated in continuing education opportunities related to credentialing standards, regulations, or accreditation requirements.
- Completed revalidation requests and re-credentialing applications.
- Supported Joint Commission accreditation surveys by providing requested documentation related to practitioner qualifications.
- Assisted with new provider orientation by explaining credentialing process and requirements.
- Cross-trained colleagues on various aspects of credentialing process to ensure continuity of services during absences.
- Served as liaison between healthcare providers and payer organizations during enrollment or contracting negotiations.
- Prepared and provided information for internal and external customers as appropriate.
- Worked closely with revenue cycle teams and billing staff members.
- Processed reappointment applications within required timeframes to ensure continuous provider participation with health plans.
- Reviewed and evaluated practitioner applications for completeness and accuracy.
Education
Certification - Claims Coding
Cypress Community College
01.2005
Skills
- NCQA/URAC
- License verifications
- Facility credentialing
- CAQH
- Credentialing oversight
- [Software] expertise
- PAVE
- Management Collaboration
- Policies implementation
- Administrative support
- Microsoft Word
- Time management
- Microsoft Excel
- File organization
- Microsoft outlook
- Customer and client relations
- Computer proficiency
- Filing
- Customer relations
- Critical thinking
- Strong problem solver
- Scheduling
- Microsoft Office Suite
- Office management
LANGUAGE
Spanish
Fluent
Timeline
Administrative Assistant
LA Care
04.2025 - Current
Administrative Assistant
Ensign
08.2024 - 04.2025
Credentialing Specialist
CalOptima
11.2022 - 07.2024
Credentialing Analyst
Verifpoint
01.2012 - 10.2022
Certification - Claims Coding
Cypress Community College
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