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Work Background
RLDatixCredentialing Specialist
Oct. 2023Remote
OptumSupport Coordinator Network Management
Oct. 2020 - Oct. 2023RemoteReceive, review and process provider file updates/change requests via verbal, electronic, or written request
Process paperless provider file updates
Review, verify, approve submitted provider/facility contracting documents for activation
Respond to/resolve incoming requests
POC for providers/internal depts with Portal Issues
Provider profile updates/clean up/project requests
Manage /maintain/update process flows and work instructions
Manually assign qualified providers to orders per contractual agreed radiai
Coast DentalSr. Credentialing Respresentative
Apr. 2019 - Oct. 2020
DaVita Medical GroupCredentialing Coordinator
Mar. 2017 - Oct. 2018Tampa/St. Petersburg, Florida AreaManage the completion and submission of provider enrollment applications for all insurance types through the Council for Affordable Quality Healthcare (CAQH) database and/or paper application Coordinate and perform follow-up with insurance payers via phone, email, fax or website to resolve provider enrollment issues and ensure timely initial credentialing/re-credentialing Process and maintain CAQH enrollments and re-attestations Coordinate communication to provider; i.e. start dates, welcome letters and appropriate provider ID numbers Work closely with the external provider enrollment departments (insurance based) to understand specific application/enrollment requirements including pre-requisites, forms required, form completion requirements, timelines, supporting documentation, and regulations Maintain documentation and reporting related to completed provider enrollments, provider enrollments in process and revalidation timelines/processes Maintain appropriate provider enrollment information in the provider regulatory credentialing repository , optimizing efficiency, and performs queries, reporting and document generation as needed Work closely with executive leadership, and appropriate clinic staff to expedite completion of forms and requirements including obtaining signatures, locating required documentation, etc… Establish and maintain close working relationships with hospital credentialing coordinators, network management, providers and other hospital/headquarter departments as appropriate and payer contacts
Shriners Hospitals for ChildrenCredentialing Specialist
Feb. 2015 - Mar. 2016Tampa/St. Petersburg, Florida AreaManage the completion and submission of provider enrollment applications for all insurance types through the Council for Affordable Quality Healthcare (CAQH) database and/or paper application
Coordinate and perform follow-up with insurance payers via phone, email, fax or website to resolve provider enrollment issues and ensure timely revalidations
Process and maintain CAQH enrollments and re-attestations
Coordinate communication to internal departments of provider start dates, welcome letters and appropriate provider ID numbers as appropriate
Work closely with the external provider enrollment departments (insurance based) to understand specific application/enrollment requirements including pre-requisites, forms required, form completion requirements, timelines, supporting documentation, and regulations
Maintain documentation and reporting related to completed provider enrollments, provider enrollments in process and revalidation timelines/processes
Assists with managed care delegated credentialing audits; conducts internal file audits
Maintain appropriate provider enrollment information in the provider regulatory credentialing repository (MD Staff), optimizing efficiency, and performs queries, reporting and document generation as needed
Work closely with hospital and executive leadership, and appropriate hospital staff to expedite completion of forms and requirements including obtaining signatures, locating required documentation, etc…
Establish and maintain close working relationships with hospital credentialing coordinators, network management, providers and other hospital/headquarter departments as appropriate and payer contacts
VeriFoneSSR - Sales Support
Nov. 2013 - Nov. 2014Clearwater, FL
EmCareAdministrative Coordinator
Apr. 2013 - Nov. 2013
Residential Finance CorporationClosing Specialist
Dec. 2012 - Apr. 2013Tampa/St. Petersburg, Florida Area
MICMortgage Closer/Doc Prep
Oct. 2011 - Dec. 2012Saint Petersburg, FlCompletion of Mortgage Closings based on VA Rules and Regulations for 27 states
Assisted in training of new hires in accordance with published rules and regulations
Cross trained on both Title Company Closing Procedures; Fee Sheets and Tax Information
Pinellas County Job CorpsPurchasing Specialist
Aug. 2011 - Oct. 2011St. Petersburg, FLPurchasing Specialist. Responsible for the entire campus supply needs from machines to erasers. Work in concert with instructors, administrators and associates (students) to meet all their needs - from clothing to food, classroom materials to field trips. (Temp Position)
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