SHAKIRA CABEZA
Mesquite,TX
Summary
Experienced in credentialing and staff coordination, ensuring compliance with industry standards and regulations. Skilled in managing credentialing processes, maintaining accurate records, and fostering collaborative environments. Expertise in provider enrollment, facility support, and regulatory adherence to enhance operational efficiency.
Overview
8
8
years of professional experience
Work History
Credentialing Specialist
MBMS, LLC
Remote
11.2023 - Current
- Facilitated enrollment of providers in various insurance plans including Medicaid and Medicare.
- Executed background checks and board certifications as part of primary source verifications.
- Streamlined departmental interactions to optimize credentialing collaboration.
- Streamlined provider and facility data by managing NPI registrations.
- Accelerated onboarding process for new providers, guaranteeing timely completion of documentation.
Credentialing Specialist
United Healthcare/Healthsmart
Remote
07.2018 - 11.2023
- Facilitated credentialing applications for new providers, guaranteeing submission of all necessary documents.
- Managed timely renewal of existing providers' credentials.
- Engaged with healthcare administrators to address credentialing concerns, maintaining adherence to protocols.
- Compiled and organized permanent files to ensure efficient approval workflow.
Patient Care Coordinator
Optum Healthcare
Dallas, TX
04.2017 - 07.2018
- Delivered outstanding customer service by swiftly handling inquiries and resolving issues.
- Compiled and recorded medical charts using specialized software.
- Leveraged electronic health records system to ensure precise entry of patient demographics, insurance details, and physician directives.
- Ensured confidentiality of medical and financial information in compliance with HIPAA.
Education
BBA - Business Administration
Bossier Parish Community College
Bossier City, LAHigh School Diploma -
South Garland High School
Garland, TX06.2014
Skills
- Credentialing
- Customer Service
- Training and mentoring
- Microsoft Outlook
- Decision-making
- Attention to detail
- Staff management
- NCQA Standards
- Federal and State Regulation on Confidentiality
- JCAHO Accreditation standards
- Peer Review Guidelines
- HIPAA compliance
- Facility credentialing
- Provider enrollment
- Facility support
- Background checks
- Application management
- Credential verification
- Credentialing documentation
- License verifications
- Documentation and recordkeeping
Timeline
Credentialing Specialist
MBMS, LLC
11.2023 - Current
Credentialing Specialist
United Healthcare/Healthsmart
07.2018 - 11.2023
Patient Care Coordinator
Optum Healthcare
04.2017 - 07.2018
BBA - Business Administration
Bossier Parish Community College
High School Diploma -
South Garland High School