Healthcare Business Management

CRISTINA GONZALES, MBA, CPCS

Telephone: 602-***-****

Email: ************@*****.***

CREDENTIALING * PRIVILEGING*HEALTHCARE SPECIALIST*TEAM PLAYER*LEADER

Fourteen years Credentialing experience and experience in various healthcare positions

Efficient leadership & team-player employment style through encouragement and motivation

Patience and talent for providing direction and delegation through interpersonal skills

Outstanding organizational skills that ensure timely work of high quality and integrity

EXPERIENCE:

Credentialing/Privileging Specialist

Mountain Park Health Center

February 2012 - February 2013

1. Credentialing/Privileging 90 plus providers for 5 service locations and a corporate office

2. Completed provider initial/recredentialing applications through all Commercial/AHCCCS plans

3. Monthly privileging for seven different specialties (IM,Peds,Dental,RD,WHC,BH,Pharm)

4. Processed hospital Credentialing/Privileging for applicable providers at Banner Good Sam

5. Liaison for internal/external customers, clinics, corporate office, billing department, contracting

6. Analyzed and investigated any problematic providers with sanctions, suspensions, and lawsuits

7. Monthly reports of active, terminated, status, issues, concerns, non-compliant providers

8. Utilized OneApp Pro Credentiaing software and Microsoft Office for maintenance of provider data

Accomplishments:

9. Twenty minute Credentialing/Privileging presentation for Operations Directors and Managers

10. Created/developed extensive grid of workflow by specialty to ensure compliance

11. Created/utilized thorough checklist in order to assure completeness of process for all providers

12. Created beneficial healthplan contact list with caveats for each plan, network management

13. Saved company several thousand dollars through project management and oversight

SUMMARY OF QUALIFICATIONS:

1. Knowledge in all areas of Credentialing, Privileging, Healthcare, Business aspects such as:

1. JCAHO, NCQA, CMS, PECOS, URAC, HIPAA, FQHC requirements

2. BOMEX, AOA, CAQH, NPDB, OIG, NPI, GACCP, DEA, CEUs, MAL INSURANCE

3. Provider Relations, Networking, Contracting, Credentialing, Policies/Procedures

4. Insurance, Benefits, Claims, Medical Records, Eligibility, Medical Terminology

5. Medical Billing, Administrative, Front Office, Customer Service, AP/AR, Payroll

6. AHCCCS, Medicaid, Medicare, Individual / Commercial Plans, Self-Insured Accounts, National and

Local Accounts and Conditions, Fee Schedules, Contracts

1. Analytical and Investigative nature. Technically skilled. Extremely well-organized, meticulous, planned,

thorough, detail-oriented with excellent time management skills especially deadlines.

2. Balanced and collaborative team leader, supervisor, and trainer with the ability to quickly and accurately

identify employee’s strengths and weaknesses (including my own) in order to achieve and accomplish the task

at hand proficiently and effectively.

3. Empowering team player. The ability to work with all types of people and work ethics to view and achieve the

broader picture of my role as well as others in accomplishing tasks and assignments correctly for the overall

benefit of the company and all stakeholders. Superior communication, interpersonal and presentation skills.

Adaptable, flexible, inquisitive and motivated.

EDUCATION: M.B.A., Business Management, Western International University, April, 2005

CERTIFICATION: Certified Professional Credentialing Specialist (CPCS), NAMSS Institute, June 2004

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