Silvienne Demosthene
North Miami,FL
Summary
Experienced Credentialing Specialist adept at conducting application reviews and primary source verifications. Excellent relationship-building, problem-solving and communication skills. Works productively with facilities, provider groups and individual professionals. Knowledgeable about application requirements for government and private insurance plans
Overview
24
24
years of professional experience
Work History
Home Health Aide
We Do It All Services
07.2022 - Current
- Assisted patients with dressing, grooming and feeding needs, helping to overcome, and adapt to mobility restrictions.
- Performed laundry, grocery shopping and other light housekeeping duties as instructed by client.
- Traveled to clients' homes to complete healthcare services and promote continuity of care.
- Provided mobility assistance such as walking and regular exercising.
- Improved patients' comfort with massage and application of topical treatments.
- Supported families through difficult times by offering emotional support and education on important care tasks.
Credentialing Specialist
MedPro Staffing
04.2000 - 08.2022
- Arrange meetings, schedule appointments and travel arrangements as requested
- Improved office efficiency by effectively managing internal communications and correspondence.
- Wrote and maintained technical documentation for software (VMS system) applications.
- Review credentialing application for accuracy and completeness, log and request missing documentation and information as needed
- Health Plan Portals (Availity)
- Developed and implemented onboarding and orientation programs for new employees.
- Verified insurance eligibility and coverage for patients.
- Maintained current knowledge of medical rules and regulations, policies and procedures and credentialing requirements.
- Maintained confidential patient, employee and company information in compliance with company policies and regulatory requirements.
- Submitted for prior authorization with required documentations
Physician Credentialing Office Specialist
Boca Care Inc
06.2012 - 06.2019
- Reviewing Credentialing Applications
- ICD-10 Coding
- Able to perform charge review, claim submission, claim follow-up, payment posting and patient statements
- Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
- Document all tasks, actions, phone calls, emails and other forms of communication during the credentialing
- Serve as liaison between health plans and provider
- Coordinated patient scheduling, check-in, check-out and payments for billing.
- Review credentialing application for accuracy and completeness, log and request missing documentation and information as needed.
Patient Access Representative
Broward Community and Family Center
06.2019 - 04.2000
- Responsibilities include maintaining knowledge of current health plans and agency requirements for credentialing new providers
- Obtain and verify current state licenses, DEA certificates, Board certifications and any other required credentialing documents for all providers including staff physicians, allied health professionals and behavioral health providers
- Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
- Provide office support services so as to make sure efficiency
- Answer incoming calls on multi-line phone and respond to public inquiries in a courteous manner within scope of knowledge and authority and refer to other persons in the Department as appropriate
- Collected and entered patient demographic and insurance data into computer database to establish patient's medical record.
- Supported office staff and operational requirements with administrative tasks.
Education
Health - Health Administration
Miami Dade College
Fort Lauderdale, FLCertificate in Business Specialist - Business Specialist
Miami Dade College
Miami, FL06.2016
Associate of Science-Human Resources - Human Resources
University of Phoenix
Marietta, GA06.2011
Medical Coding and Insurance Billing - Medical Coding And Billing
Everest University
Pompano Beach, FL06.2011
Skills
- Application Coordination
- Proofreading
- Regulatory Compliance
- Management Collaboration
- VMS Systems
- Provider Relations
- Credentialing Oversight
- New Hire Onboarding
- HEDIS
- ICD10
- Microsoft
- Bilingual
- Outlook
- Human Resources Support
- Insurance Procedures
- Customer Service
- Critical Thinker
Languages
Haitian Creole
Native or Bilingual
Timeline
Home Health Aide
We Do It All Services
07.2022 - Current
Patient Access Representative
Broward Community and Family Center
06.2019 - 04.2000
Physician Credentialing Office Specialist
Boca Care Inc
06.2012 - 06.2019
Credentialing Specialist
MedPro Staffing
04.2000 - 08.2022
Health - Health Administration
Miami Dade College
Certificate in Business Specialist - Business Specialist
Miami Dade College
Associate of Science-Human Resources - Human Resources
University of Phoenix
Medical Coding and Insurance Billing - Medical Coding And Billing
Everest University
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