Vanessa Valle
San Antonio,TX
Summary
Experienced Credentialing Specialist with a keen eye for detail and a dedication to delivering outstanding service. Demonstrated expertise in credentialing medical providers and allied health professionals. Excellent communication skills, adept at building and maintaining professional relationships via email and phone interactions with providers, licensure boards, health plans, and team members. Proficient in utilizing various professional platforms. Also holds a Texas Notary license.
Overview
14
14
years of professional experience
Work History
Credentialing & Licensing Specialist
Quadrant Biosciences Inc
San Antonio, TX
01.2023 - 07.2024
- Well versed in medical licensure process for all States
- Assist providers with medical license application process and submission
- Assist with any deficiencies and responded to inquiries from state medical boards
- Primary source verification of all new provider credentials
- Assist providers with Interstate Medical Licensure Compact applications
- Create and update Federation of State Medical Boards profiles
- Maintain and update and attest CAQH profiles
- Maintain and update all licensed staff credentials in our Google drive spreadsheets
- Coordinated Fingerprinting and Background check appointments for providers in multiple states
- Conducted Remote Online Notaries for our providers
- Track and notify providers of expiring credentials and assist with renewal applications
Senior Credentialing Specialist
Strivant Health
Remote
01.2022 - 01.2023
- Facilitate the credentialing and re-credentialing process for new applicants to the client medical staff
- Complete provider enrollment process with Medicare, Medicaid, and various health payors from different states
- Maintain credentialing documentation and filing system on company's SharePoint including payor approvals and staff credentials
- Maintain client information in Availity, CAQH, PECOS, and other payor portals including performing quarterly audits and attestations
- Coordinate and drive all credentialing vendor communications and oversee the audit results of the vendor output
- Monitor the Credentialing department email box and respond timely to emails and telephone messages
HR Credentialing Coordinator
The Center for Health Care Services
San Antonio, TX
06.2017 - 01.2022
- Compensation and Benefits: Executes benefit access for new employees upon first day of hire ensuring system access for benefit election utilizing MUNIS software
- Audits and corrects data entry discrepancies
- Ensures all beneficiary and dependent information is accurately transmitted to multiple carriers in MUNIS software
- Facilitated annual open enrollment utilizing video software (Zoom)
- Credentialing: Facilitate the credentialing and re-credentialing process for new and existing licensed staff with our various payors utilizing CAQH and facility rosters
- Facilitate the credentialing and re-credentialing process for our facilities by ensuring all facility license, certifications, and DEA are up to date
- Conduct OIG Federal and State, EMR, and NPDB queries
- Perform primary source verifications of professional licenses, certifications, and DEA certificates
- Monitor and maintain licensure to ensure renewal in a timely manner and inform applicable departments of any non-compliant providers
- Maintain and update all licensed staff credentials in CACTUS, Anasazi, and My Avatar database
- Establishes a rapport with our external representatives while enrolling and tracking the credentialing status with our contracted payors
- Monitor correspondence from payors including approval or deficiency letters, and updating databases and stakeholders
Credentialing Specialist/Govt Contractor
Decypher Technologies
San Antonio, TX
05.2016 - 06.2017
- Conduct PSV of licenses, certifications, registrations, professional school education, postgraduate, residency, specialty training, board certifications, work history, and current references
- Conduct queries through NPDB clearinghouse, NSCH, TRICARE, and DHHS
- Accurately load appropriate data in the DoD CCQAS credentialing database and maintain the data
- Research and resolve credentialing/re-credentialing problems
- Perform a variety of routine clerical functions and projects as assigned
- Maintain relationships with Military Treatment Facilities and supported customers.
Credentialing Specialist/Govt Contractor
Random E Network
Lackland AFB, TX
04.2015 - 05.2016
- Conduct PSV of licenses, certifications, registrations, DEA certificates, specialty training, board certifications, work history, and current references
- Prepare and review provider files for appropriate documentation required for hospital privileges
- Coordinate with staff to receive missing credentialing information from non-compliant providers
- Route provider files through the Credentialing Committee
- Ensure compliance of Air Force credentialing procedures
- Track license and certification expiration for all providers to ensure timely renewals
- Maintain and update all staff providers in our CCQAS credentialing database
- Coordinate with medical staffing agencies to receive complete provider files for potential candidates.
Credentialing Clerk
San Antonio Kidney Disease Center Physicians Group
San Antonio, TX
12.2014 - 04.2015
- Responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals and patient care facilities
- Track license and certification expirations for all providers to ensure timely renewals
- Maintain copies of current state licenses, DEA certificates, malpractice coverage, health records, and any other required credentialing documents for all providers
- Maintain and update all providers CAQH profiles
- Maintain and log all providers CME certificates and credits
- Responsible for reviewing and maintaining all contracting correspondence.
Provider Relations Specialist
Superior Health Plan
San Antonio, TX
02.2012 - 10.2013
- Serve as primary contact for providers serving as a liaison between the provider and the health plan
- Receive and respond to external provider related issues within the established turn around times
- Initiate entry or change of provider related database information and oversee testing and completion of change request
- Investigate, resolve and communicate provider claim issues and changes
- Initiate and update claims projects if the issue impacted more than 10 claims
- Educate providers regarding policies and procedures related to referrals and claims submission, web site education, EDI solicitation and problem solving
- Create work processes on training material for fellow team members and new hires
- Audit provider contracts via Emptoris to ensure proper loading into Amisys.
Billing Specialist
Heart and Vascular Institute of Texas
San Antonio, TX
11.2010 - 02.2012
- Processed billing for a cardiology practice with 8 providers involving reviewing eligibility, initiating claims, and working with patients and insurance carriers to guarantee payment
- Identifying and resolving any and all outstanding issues preventing claim resolution
- Posting of all commercial and government payments, denials, refunds, appeals to patient accounts
- Initiate collection calls to patients with invoices past due, establish mutually agreeable payment solutions, and track account activity to ensure follow through
- Assisting patients over the phone and in person with balance inquiries
- Balance EOD cash deposit flow from our facility and 4 satellite offices
- Met departmental goals on a monthly basis to reduce A/R days.
Education
Certificate - Medical Front Office
San Antonio College
San Antonio, TX08.2010
Certificate - Certified Nurse's Aide
Texas Careers
San Antonio, TX01.2009
Diploma -
Luther Burbank High School
San Antonio, TX01.2005
Skills
- Managed Care
- Availity
- PECOS
- NPPES
- CAQH
- IMLC
- FSMB
- CACTUS
- Adobe Pro
- Microsoft Excel, Outlook and Word
Personal Information
Title: Senior Credentialing Specialist
Timeline
Credentialing & Licensing Specialist
Quadrant Biosciences Inc
01.2023 - 07.2024
Senior Credentialing Specialist
Strivant Health
01.2022 - 01.2023
HR Credentialing Coordinator
The Center for Health Care Services
06.2017 - 01.2022
Credentialing Specialist/Govt Contractor
Decypher Technologies
05.2016 - 06.2017
Credentialing Specialist/Govt Contractor
Random E Network
04.2015 - 05.2016
Credentialing Clerk
San Antonio Kidney Disease Center Physicians Group
12.2014 - 04.2015
Provider Relations Specialist
Superior Health Plan
02.2012 - 10.2013
Billing Specialist
Heart and Vascular Institute of Texas
11.2010 - 02.2012
Certificate - Medical Front Office
San Antonio College
Certificate - Certified Nurse's Aide
Texas Careers
Diploma -
Luther Burbank High School