ROYA BEUOKAGHAEI

My extensive experience includes overseeing the credentialing department for provider and group credentialing, re-credentialing, and payer enrollment with top Medicaid, Medicare, and Commercial health plans across multiple states. I have managed onboarding for hospital and surgery center privileges and handled group state and individual licensure/certification applications nationwide for various medical professionals.

I am skilled in maintaining provider data in CAQH, PECOS, NPPES, Availity, and insurance portals, and have experience with CLIA and Secretary of State licensing. My background includes thorough primary source verifications and ensuring timely renewals of licenses, DEA registrations, pharmacy license and malpractice documentation.

I collaborate effectively with internal and external departments for provider enrollment and liaise with payers and agencies to ensure prompt application processing. I have a strong understanding of NCQA, DHCS, CMS, The Joint Commission, and state regulations. Additionally, I possess leadership and team management skills and knowledge of health plan contracts for providers and the group to negotiate for a better reimbursement rates and fee schedules.

My accomplishments include reducing processing times, expediting issue resolution, streamlining credentialing processes, and successfully managing new provider onboarding

My responsibilities include overseeing provider and group credentialing, re-credentialing, and payor enrollment with Medicaid, Medicare, MCOs, and commercial health plans.

Additionally, I manage initial and reappointment onboarding and enrollment for hospital and surgery center privileges.

Maintaining current and accurate provider data across platforms such as CAQH, PECOS, NPPES, Availity, and various insurance portals is also key, including timely renewals of licenses, DEA registrations, pharmacy certifications, and malpractice documentation.

I am self-motivated with a strong sense of personal responsibility. In previous roles, I have consistently contributed to daily operations, working efficiently and productively with team members. I use critical thinking to analyze challenges, assess solutions, and make informed decisions. I have a proven record of meeting deadlines and thriving in fast-paced environments, working both independently and collaboratively.

Collaborated with healthcare providers to gather credentialing information.

Managed multiple priorities to complete credentialing tasks on time for numerous providers.

Audited provider files to ensure up-to-date and compliant documentation.

Enrolled providers with Medicaid, Medicare, and private insurance plans.

Conducted primary source verifications, including background checks and board certifications.

Reviewed applications for missing or inaccurate information.

Demonstrated problem-solving skills in resolving complex credentialing issues.

Enhanced credentialing processes by streamlining documentation and verification.

Developed strong relationships with external organizations to improve verification cooperation.

Expedited new provider onboarding by ensuring timely completion of documentation and verifications.

My responsibilities include processing provider credentialing and onboarding with various health plans, encompassing data entry, report generation, and creating tracking documents. I also gather and organize credentialing materials.

Previously, I enhanced customer satisfaction by promptly addressing health plan inquiries. I effectively prioritize and manage multiple projects, consistently meeting deadlines while maintaining quality.

To improve efficiency, I delegated tasks to support staff. I am also meticulous with audit documentation, ensuring regulatory compliance, and have a track record of building strong client relationships.

Reviewing initial and reappointment credentialing applications and managed revalidation for payors and facilities. I contacted insurance carriers to resolve application denials and collaborated with credentialing teams to verify provider qualifications. I monitored credential expirations and contacted practitioners as needed. Meticulous review procedures have reduced errors. Collaboration with cross-functional teams helped resolve enrollment issues and improve customer satisfaction. I managed escalated enrollment cases professionally. My responsibilities include preparing and processing Medicare and Medicaid enrollments across multiple states. Additionally, I assisted clients with application and paperwork completion.