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YARIZA RODRIGUEZ

* ******* **** **** #** BRONX, NY 10468 T: 646-***-**** abggsm@r.postjobfree.com

Objective:

To obtain a challenging position utilizing my skills in a company that will foster growth and advancement based on

initiative and contribution.

Carrier summary:

A growth-oriented and detail oriented seasoned Credentialing professional with a strong background in Credentialing

and physician onboarding processing physician enrollment applications. Over 10 years experience in the healthcare

industry. Expertise in coordinating provider applications and the re credentialing process. Highly organized with

excellent administrative, leadership and time management skills. Adept at working with health plan providers and

members, as well as excellent communication and leadership skills.

Job Skills:

• Experience working in fast paced environments demanding strong organizational, Analytical thinking,

decision making and problem solving skills

• Excellence Personal Communication skills

• Conflict resolution

• Skilled at fostering interdepartmental relationships

• Detail oriented and resourceful in completing all job duties; able to multi-task effectively.

• Strong writing skills

• Proficient in Microsoft Office Suite programs, MS Excel, MS Word, Outlook Express, Scanning,

Advanced Internet Search, PECOS, NPPES,CACTUS, CAQH, Epic, Business Objects, Access and

Bilingual (Spanish)

PROFESSIONAL EXPERIENCE

NYU SCHOOL OF MEDICINE, NY 1/2011 -present

FGP Credentialing/Enrollment Coordinator (Managed Care)

Responsible for reviewing, inputting and tracking high volume Provider

Credentialing applications to ensure timely and efficient enrollment in the

contracted managed care plans.

Prepared and maintained the entire onboarding credentialing process through

CAQH.

Daily use and maintenance of CACTUS database to ensure all applicants are

enrolled effectively.

Work collaboratively with NYU partners in malpractice insurance, claims, and

revenue cycle operations.

Working knowledge if insurance regulations pertaining to provider enrollment

with payers.

Proficiency working with 855 series forms, PECOS and NPPES online systems.

Responsible for the management of 1,500 faculty group practice physician

onboarding process related to new acquisitions for all FGP providers.

Worked closely with all practices business administrators to ensure timelines

and deliverables are met for a seamless transition and successful

implementation.

Run participation reports on Business Objects database.

Prepared and maintained the Medicare revalidation process along with W-9

inquiries.

Prepare and maintained all CMS provider enrollment and other government

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programs.

Developed and maintained positive relationships with physicians, human

resources administrators and managed care organization representatives and

internal staff.

Responsible for follow up of returned applications to physicians for missing

information.

Responsible for producing and maintaining weekly and monthly enrollment

reports.

Manage the ongoing process for all physician disenrollment’s, recredentialing

and opt outs from managed care plans.

Implemented all eligible professionals meet the Meaningful Use criteria.

Responsible for tracking the status of applications, while updating database

with accurate provider identification numbers upon enrollment.

Verify the correct loading of physician demographic and tax identification

information in payers system as well as FGP system.

Reviewed provider participation rosters to ensure accuracy and compared

information to the FGP database.

Informed Manager of delays related to the enrollment process and assisted in

taking the appropriate action steps to ensure timely and accurate enrollment.

Assisted with credentialing and other Epic operational projects as needed.

HEALTHFIRST, NY

Credentialing Coordinator 10/2006 - 1/2011

Responsible for Credentialing and Recredentialing of HFNY and HFNJ facilities Level 1, 2 and 3

Providers ensuring the credentialing documents are complete and in accordance with the

Healthfirst credentialing policies and procedures.

Reviewed applications and prepared verification letters along with all approval letters.

Logged and created files for new Level III practitioner applications.

Collect and maintain files in relation to credentialing of network providers, including application, contracts,

current physician licenses, DEA licenses, malpractice insurance, board

certifications and other pertinent forms.

Understanding of NCQA Credentialing Guidelines.

Input data needed for electronic query of National Practitioner Data Bank, CACTUS, AMA,

Physician Profile and Office of Quality Audit for practitioners.

Updates credentialing log and individual practitioner files as reports queried agencies are received.

Prepared materials for and attended Health Care Quality Meetings.

Interface between providers and hospital staffs to collect required information.

Prepared, transcribed, composed and typed minutes of the HFNY and HFNJ credentialing

meetings.

Provided reports and updates as requested on the status of the credentialing process.

Scheduled travel arrangements for managers and directors.

Researched NY and NJ State practitioners backgrounds through Credentialing Websites

( NYSED, NPPES, NJDCA, OPMC, OIG, NJDCA-OAG,HPN, OFAC, OPT-OUT)

Assist Director in Annual State Audits and Compliances Procedures.

Maintained CACTUS database.

Interface between providers and hospital staffs to collect required information.

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Submit applications to manager, medical director and Credentialing Committee for review.

HEALTHFIRST, NY 3/2004 - 10/2006

Quality Improvement Coordinator

Medical records review/auditing using structured criteria.

Knowledge of HEDIS/QARR, QISMC and NCQA standards.

Outreached, telephonic and written educational interventions.

Created and implemented clinical programs designed to improve member and provider compliance

with nationally accepted clinical practice guidelines.

Served as administrative assistant to the management team, functioned as primary liaison to members

and providers while ensuring a consistently positive customer experience.

Actively participated in all clinical activities and action plans to improve plan performance in

HEDIS/QARR initiatives.

Actively engaged in quality activities designed to promote and support member and provider

satisfaction.

Promoted and ensured provider compliance with required medical record documentation standards

including assistance with the review and collection of medical records.

Track trends of member satisfaction surveys.

Reported and participated in committee discussions to improve member satisfaction.

Implemented quality of care corrective action plans.

Scheduled and coordinated meetings, interviews, appointments, events and other similar activities for

supervisors, which also included travel and lodging arrangements.

Provided administrative/secretarial support for the Quality Improvement Department such as

answering phones, greeting and assisting visitors and resolving a range of administrative problems

and inquiries.

LLOYD STAFFING (TEMP AGENCY), NY 9/2001 - 3/2004

Freelance Administrative Assistant

Experienced in all aspects of administrative work including answering heavy telephone, transcribing minutes,

filing, data entry and coding, mail distribution, scheduling and inventory control for the following clients:

Solil Management - Accounts payable/bookkeeping.

Goldman Sachs – Customer Service Associate.

H.I.P Health Insurance of New York – Triage Operator.

O.R.C. MACRO INTERNATIONAL, NY 1/2001- 9/2001

Marketing Receptionist

Answered multi-phone line to screen, forward and take messages.

Organized and coordinated focus groups for marketing research.

Responsible for making domestic and international travel arrangements for senior-level executives via

the Internet, which resulted on a net saving of $175 - $250 per round-trip airfare ticket.

Input data entry on surveys.

Handled incoming and outgoing mail.

Clerical duties.

Responsible for maintaining client relations.

Manage and maintain office inventory

Compose and distribute inter-departmental memorandums (e-mail, documentary and voice) ensuring

timely delivery and receipt of important information while at the time maintaining confidentiality.

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Plan and coordinate corporate luncheons, and develop presentations for related on-site and off-site

meetings.

EDUCATION

• St. Michael Academy, NY : Academic Diploma (1996)

• St. John University, NY : Pursuing a Degree in PR/Business Management

REFERENCES

Furnished Upon Request

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