Experienced administrative professional with 4+ years in provider credentialing services. Works productively with facilities, provider groups and individual professionals and adept at conducting application reviews and primary source verifications. Excellent relationship-building, problem-solving and communication skills.
Overview
17
17
years of professional experience
Work History
Credentialing Specialist II
Parallon Business Performance Group
10.2022 - Current
Responsible for credentialing activities as it relates to initial credentialing, re-credentialing, and credentials modification
Assist in credentialing process by data entry of information into credentialing system for initial, updated; add on applications and maintenance processes
Review for completeness of information, identify deficiencies
Pursue incomplete information
Monitor collection of all information received; follow up on missing items and/or incomplete forms per policy and procedure, and submission of follow up requests for verifications
Maintain all credentials files ensuring that all correspondence regarding credentialing and reappointment process is accurately filed and current on process and legal/regulatory requirements.
Enhanced credentialing processes by streamlining documentation and verification procedures.
Improved turnaround time for credentialing applications by implementing efficient online system.
Credentialing Verifier
Parallon Business Performance Group
03.2019 - 10.2022
Improved verification accuracy by implementing thorough quality control processes and procedures.
Enhanced team efficiency by streamlining workflows and optimizing communication between departments.
Reduced turnaround time for verification tasks by prioritizing workload and managing resources effectively.
Developed strong relationships with clients, ensuring timely delivery of accurate information.
Maintained high levels of customer satisfaction through consistent attention to detail and prompt resolution of issues.
Trained new employees on company policies, procedures, and verification techniques, contributing to overall team success.
Collaborated with colleagues on special projects, ensuring successful completion within deadlines.
Admit Clerk/Patient Access Registrar
HCA Florida Orange Park Hospital
11.2015 - 03.2019
Accomplish admissions and hospital mission by completing related results as needed
Review and request insurance coverage for newborn accounts and update insurance information once coverage is active
Register patients; update demographic and insurance information to help maintain accuracy
Verify insurance and other eligibility criteria
Review insurance information on accounts to help minimize billing errors
Prepare and process all admitting forms relating to patient admission
Communicate patient rights, billing and payment procedures to patients or their families.
Increased efficiency by streamlining filing systems and organizing important documents.
Improved customer satisfaction by promptly answering inquiries and providing accurate information.
Managed incoming calls professionally, directing callers to appropriate personnel or taking detailed messages when necessary.
Credit Customer Service and Data Integrity Associate
General Electric Company
01.2007 - 08.2015
Processing new credit application and correcting incorrect information already submitted, by contacting customer by phone within stipulated period
Collected customer feedback and made process changes to exceed customer satisfaction goals
Plans and coordinate learning projects for benefit of peers
Developed strong client relationships through timely and thorough follow-up on inquiries and concerns.
Led training sessions for new employees to ensure smooth integration into company culture and workflow.
Increased customer satisfaction by resolving complex issues and providing exceptional service at all times
Education
BBA - Business Management
University of Puerto Rico - Bayamon
Bayamon, PR
06.2003
BBA - Business-Marketing
University of Puerto Rico - Bayamon
Bayamon, PR
06.2004
MBA - Global Management
University of Phoenix
Guaynabo, PR
09.2011
Master of Science - Management and Leadership
Western Governors University
Salt Lake City, Utah
01.2024
Skills
Bilingual
Excellent written and verbal communicator
Self-directed
Collaborative
Active listening skills
Credentialing Oversight
Provider Relations
Data Management
Cactus Expertise
Facility Support
Accreditation Information Management
Ethical Conduct
Analytical Skills
Report Generation
Accomplishments
NCAA Olympic Weightlifting Medalist
References
Available upon request
Languages
Spanish
Native or Bilingual
English
Full Professional
Affiliations
National Black MBA Association
Timeline
Credentialing Specialist II
Parallon Business Performance Group
10.2022 - Current
Credentialing Verifier
Parallon Business Performance Group
03.2019 - 10.2022
Admit Clerk/Patient Access Registrar
HCA Florida Orange Park Hospital
11.2015 - 03.2019
Credit Customer Service and Data Integrity Associate
General Electric Company
01.2007 - 08.2015
BBA - Business Management
University of Puerto Rico - Bayamon
BBA - Business-Marketing
University of Puerto Rico - Bayamon
MBA - Global Management
University of Phoenix
Master of Science - Management and Leadership
Western Governors University
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