Sandy Sandoval

Managed comprehensive payer enrollment and credentialing activities across Medicare, Medicaid, commercial, and pharmacy sectors.Prepare, review, and submit enrollment applications and supporting documentation, ensuring accuracy and completeness to minimize delays or rejections.Monitor and track the status of all enrollment activities using designated tracking tools and systems, maintaining accurate and up to date records.Manage end-to-end credentialing processes including initial appointments, and reappointments,Perform and track background checks and verifications.Ensure compliance with accrediting bodies, regulations, and internal policiesMaintain accurate and up-to-date provider records with strong attention to data integrityInterpret credentialing standards, bylaws, and applicable laws to ensure full compliance

Other assigned duties

Oversaw the review process for applications, ensuring completeness through primary source verification of licensure, board certification, and any disciplinary actions. Proactively identified areas requiring additional investigation or follow-up. Managed the collection and processing of medical staff reappointments, ensuring timely completion within established deadlines. Developed and maintained various tracking systems to guarantee that processing aligns with regulatory requirements and accreditation standards related to credentialing.

Achieved timely completion and forwarding of credentialing, re-credentialing, and file maintenance files for client organization providers, enhancing operational efficiency. Streamlined processing of customer organizations' credential files through effective use of the eCreds database, resulting in improved accuracy in data entry and fulfillment of mail-room tasks. Delivered accurate primary source verifications of medical education and licensure, contributing to the thorough completion of credential files for providers of customer organizations.

Coordinated and facilitated daily practice functions and activities of Radiologist and Physician Assistant (PA) members of the Sutter Medical Group Division of Medical Imaging. Works closely with Diagnostic Imaging leadership at the various acute care and outpatient facilities to assure adequate Radiologist staffing that is compliant with the entity credentialing and privileging criteria, reimbursements, all licensure and certification requirements are met on a timely manner. Answers and return phone calls/ emails and sort incoming inter-office/outside mail on a daily basis.

Coordinated and facilitated daily practice functions and activities of Radiologist and Physician Assistant (PA) members of the Sutter Medical Group Division of Medical Imaging. Worked closely with Diagnostic Imaging leadership at the various acute care and outpatient facilities to assure adequate Radiologist staffing that is compliant with the entity credentialing and privileging criteria, reimbursements, all licensure and incoming phone calls/emails and sort incoming inter-office/outside mail on a daily basis.

Responded to incoming calls by submitting new requests for leave (RFL) for Sutter Health employees specific to Pregnancy Disability Leave (PDL); Military Leave; Personal Leaves (PLOA); the Family Medical Leave Act (FMLA and California Family Rights Acts (CFRA). Identified internal leave specialists assigned to a case, walking through the leave application process to all employees and taking other miscellaneous calls. Sent updates to managers on employees who have requested a leave and who their designated leave specialist is including any other projects that are assigned. Contacted all employees and managers acknowledging receipt of RFL, employees who are on a leave at the time of transition to advise who the leave specialist is and what roles and responsibilities for communication while off work.