Valerie Valdez
Provider Enrollment / Credentialing Coordinator
Manor
Summary
Experienced with credentialing processes and regulatory compliance in healthcare sector. Utilizes efficient database management and meticulous record-keeping to ensure accuracy and timeliness. Strong understanding of teamwork dynamics and adaptability, contributing to operational success.
Overview
11
11
years of professional experience
Work History
Credentialing Coordinator
MB2 Dental
06.2023 - Current
- Verified and maintained all provider credentials, including state licenses, DEA/CDS registrations, degrees, CVs, and other compliance documents.
- Entered and audited fee schedules within the practice management system (PMS), ensuring accuracy across multiple office locations.
- Managed provider enrollment with multiple payers, completing follow-ups through approval and handling re-credentialing as required.
- Created, updated, and maintained CAQH and ADA portals to ensure provider information remained accurate and compliant.
- Resolved complex insurance claim issues by liaising with payers, reducing payment delays and supporting office staff in achieving timely reimbursements.
Credentialing Coordinator
Center for Autism and Related Disorders, LLC
09.2021 - 07.2023
- Organize, verify, and maintain credentialing files for practitioners.
- Track and update certifications, state licenses, and re-credentialing requirements to ensure compliance.
- Submit credentialing applications to multiple funders for approval of providers across diverse insurance plans.
- Maintain online systems for provider credentialing and re-credentialing.
Program Coordinator
Superior Health Care
01.2018 - 03.2021
- Processed and approved authorizations for long-term care services.
- Verified agency credentials (NPI, TX ID) and member eligibility with Medicaid.
- Coordinated authorizations for PAS, ERS, PS, HAB, HDM, respite care, and adult day care.
- Managed communication between agencies and physician offices to ensure continuity of care.
Referral Coordinator/Specialist
Superior Health Care
10.2017 - 01.2018
- Verified member eligibility and agency credentials with Medicaid.
- Reviewed CPT and diagnosis codes to determine authorization requirements.
- Prepared authorizations and coordinated with nurses for approval.
- Scheduled inpatient, outpatient, transportation, and office visit services.
Provider Enrollment Specialist
W3R Consulting (Accenture)
02.2016 - 09.2016
- Enrolled and renewed providers to ensure timely Medicaid reimbursement.
- Verified provider credentials, licenses, and agency compliance.
- Conducted OIG checks to confirm providers had no sanctions or restrictions.
Referral Specialist/Coordinator
Superior Health Care
01.2016 - 07.2016
- Handled credential verification, authorizations, and member eligibility.
Customer Service Representative
Superior Health Care
11.2015 - 01.2016
- Assisted members with pharmacy-related inquiries and escalations.
Customer Service Rep / Enrollment Broker
AppleOne Employment Services (Maximus, Inc)
07.2014 - 05.2015
- Assisted members with Medicaid eligibility, enrollment, and plan selection.
- Scheduled appointments and educated members on available benefits.
- Resolved escalated issues to ensure positive member experience.
Education
GED -
Austin Academy
AustinSkills
- Credentialing & Provider Enrollment
- Insurance Verification & Authorizations
- Medical Billing & Coding (CPT, ICD-9, ICD-10)
- Medicaid / Insurance Compliance
- Medical Records & Documentation
- Microsoft Office Suite (Word, Excel, Outlook, Teams)
- Strong Communication & Interpersonal Skills
- Organizational & Multitasking Abilities
- Issue identification and resolution
- Data entry proficiency
Timeline
Credentialing Coordinator
MB2 Dental
06.2023 - Current
Credentialing Coordinator
Center for Autism and Related Disorders, LLC
09.2021 - 07.2023
Program Coordinator
Superior Health Care
01.2018 - 03.2021
Referral Coordinator/Specialist
Superior Health Care
10.2017 - 01.2018
Provider Enrollment Specialist
W3R Consulting (Accenture)
02.2016 - 09.2016
Referral Specialist/Coordinator
Superior Health Care
01.2016 - 07.2016
Customer Service Representative
Superior Health Care
11.2015 - 01.2016
Customer Service Rep / Enrollment Broker
AppleOne Employment Services (Maximus, Inc)
07.2014 - 05.2015
GED -
Austin Academy
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