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Credentialing Specialist

Location:
Miami, FL
Posted:
September 11, 2018

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Resume:

Patricia Miguel- Arrazola

***** ********* **** ****, *****, FL 33184 Cell: 786-***-**** ac60lt@r.postjobfree.com

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Summary

Performance driven professional 15 years of combined expertise in Human Resources and Healthcare Administration. A creative

thinker, problem solver and decision maker who effectively balances the needs of employees with the mission of the organization.

Skills

Medical Terminology

Talent Acquisition & Training

Surgical Terminology

Employee Relations HR

Medical Billing ECHO/

Compliance Performance

OneApp

Management

HIPAA /OSHA Certification

Compensation/Payroll

Computer literate and knowledgeable of

Regulatory Compliance

Microsoft Applications

Work History

Credentialing / Manage Care Coordinator, 04/2018 to Present

CARE RESOURCE COMMUNITY HEALTH CENTERS, INC. – Miami, FL

Responsible for processing on boarding applications of Medical Providers and Allied Health

Providers, Dental Providers and Behavioral Health Providers for Community Health Centers.

Maintained and monitored the credentialing and recredentialing process for Medicare, Medicaid and

Commercial Insurances.

New Enrollment and Reassignments of benefits for Medicare and Medicaid.

Regularly communicated to medical and finance staff on all health plans enrollments and updates.

Maintained and updated providers credentials were current and updated on CAQH, PECOS and

NPPES portals.

Created and reviewed computerized record management systems to record and process data

maintaining confidentiality of all Physician information.

Utilized primary source verification for accuracy of the qualifications of individual healthcare providers.

Provided support to management and guidance to staff to ensure work is performed in an efficient, timely

and knowledgeable manner.

Prepare and maintain reports and spreadsheets on all contracting and credentialing activities as required for

medical and finance staff.

Assist supervisor in ensuring financial management, including budgets research and processes of new health

plans applications for the health center and providers.

Managed health plans enrollments by increasing plan acceptance and participation for the health centers and

all providers.

Provided leadership in strengthening internal communications with staff at all levels throughout the

organization; created and promoted a positive and supportive work environment utilizing the health center’s

3C’s of service.

Credentialing Specialist, 08/2017 to 01/2018

GASTRO HEALTH, LLC – Miami, FL

Responsible for the on boarding of medical providers to Gastro Health, LLC and Galloway

Anesthesia Associates, LLC.

Reviewed that all credentials were in good standing.

Enrollment and Reassignments of benefits to Gastro Health, LLC for Medicare and Medicaid.

Obtained enrollment privileges for Hospitals and Ambulatory Surgery Center.s

Maintained and updated provider credentials on CAQH, PECOS and NPPES.

Created and reviewed computerized record management systems to record and process data

maintaining confidentiality of all physician information.

Utilized primary source verification for accuracy of the qualifications of individual healthcare providers.

Provided support to management to ensure all the medical offices were fully compliant with HIPAA and

Joint Commission guidelines.

Comply with the timely completion of all training requirements set by Health Care Administration

Department.

Human Resources Manager, 06/2016 to 06/2017

ELA HEALTH GROUP – Miami, FL

Managed all aspects to create, improve and implement all policies and procedures abiding by labor law

regulations.

Organized the department in accordance with administrative guidelines to provide specified healthcare

services to meet the legal, organizational and medical staff guidelines. Recruited, hired, trained and

coached on average of 80+ new employees in a year. Administered benefits plans for 80+ employees in

different states, and implemented job

descriptions, employee handbooks, effective employee applications, background screenings and drug

testing.

Assisted processing payroll with department managers.

Encouraged creative thinking, problem solving, and empowerment as part of the facility

management group to improve morale and teamwork.

Routinely collaborated with department managers to correct problems and improve services. Established

standards for selection, promotion and termination of staff.

Skillfully developed departmental goals, objectives, standards of performance, policies and

procedures.

Conducted staff meeting with office mangers once a week to discuss, monitoring employees to and

development to encourage employee’s growth within the organization. Identified process improvements

in the day to day functioning of the department. Facilitated working together with the credentialing

department to help with physician state license enrollment, as well as contracts with state and private

insurance agencies

Closely collaborated with management team to make necessary improvements and satisfy employee

and organizational needs.

Established staff schedules and assignments based on facility needs and equipment availability.

ensure they are meeting work performance requirements, wages, promotions, staffing, training.

Credentialing Specialist, 11/2014 to 06/2016

CONSULTANTS IN NEUROLOGICAL SURGERY, LLP – Miami, FL

Oversaw all aspects of the credentialing for 8 physicians and physical therapy center. Continually

maintained current provider information in online credentialing database. Retrieved copies of all

current state licenses, DEA certificates, malpractice coverage and certifications.

Achieved high staff morale and retention through effective communication, prompt problem resolution,

proactive supervisory practices and facilitating a proactive work environment. Routinely processed

enrollment and re enrollment applications to healthcare organizations and hospitals.

Continued education on knowledge of current health plan and agency requirements for

credentialing.

Processed request for provider numbers with healthcare organizations, ensuring compliance with

regulations.

Responded to inquiries from other healthcare organizations.

Maintained confidentiality of all provider information.

Office Manager, 11/2013 to 10/2014

PRIMECARE OF CORAL GABLES – Miami, FL

Managed 17 employees on daily medical office operations.

Conducted all Administrative duties.

Prepare and submitted payroll for all employees.

Posted all payments and printed checks through quick books.

Recruiting, interviewed and assisted in selection of applicants.

Explained all new hires benefits, guidelines and procedures. Direct

personal training for all departments.

Responded to all employee questions and concerns on a timely manner.

Served as a link between physicians and employees by handling questions and concerns. Assist

employees with problem solving and patient concerns.

Ensured superior patient experience by addressing patient concerns, demonstrating empathy and

resolving problems on the spot.

Strategically planned methods to achieve operational goals and targets.

Consistently complied with applicable laws and regulations and ensured facility adhered to

Medicare and Medicaid regulations.

Developed a system of staff communication that ensured proper implementation of treatment plans and

comprehensive patient care.

Surgical Coordinator, 05/2011 to 11/2013

GYN ONCOLOGY OF MIAMI – Miami, FL

Led and coordinated all surgery scheduling for two physicians and commuted to three separate

location's.

Obtained all patient's insurance verifications and authorization's prior to out patient and in patient

surgeries.

Educated patient's by explaining surgery procedure and prepared them with all the

information needed prior to surgery.

Confidently managed all collections of payments for surgeries and hospital fees. Assisted in resolving and

satisfying patient's requests and internal operational issues. Responsible for setting up cancer patients with

chemotherapy and their medication's. Effectively coded all surgical procedures for hospital scheduling

orders and billing department. Coordinated combined surgeries with other surgeons.

Certified that patients had pre operative testing prior to surgery.

Confirmed accurate completion of forms/reports for the admission, transfer and/or discharge of each

resident.

Office Manager, 02/2004 to 05/2010

DOWELL ORTHOPEDIC APPLIANCES, INC – Miami, FL

Confidently managed the overall operation of clinical services and patient care, quality assurance, patient

care, safety risk management, patient satisfaction, and facility maintenance. Recruited, hired, trained and

coached on new employees.

Processed payroll for all staff.

Maintained all employee records and human resource responsibilities, including employee handbook,

benefits, and resolving employee issues.

Skillfully performed all secretarial duties, both personal and office related. Supervised

and managed the daily activities of a clinical team and support staff.

Oversaw private and MCR billing, payroll, AP, and AR and verified that proper procedures were

followed.

Consistently complied with applicable laws and regulations and ensured facility adhered to

Medicare and Medicaid regulations.

Credentialed facility with private healthcare organization's and workers compensation agencies.

Certified that equipment and supplies were properly maintained for quality patient care and

safety.

Credentialing/Authorization Specialist, 09/2000 to 02/2004

LAPROSCOPIC CENTER OF SOUTH FLORIDA – Miami, FL

Led credentialing department for a group of four physicians.

accompanying documents, for all the enrollment and re enrollment for healthcare agencies

and hospitals.

Continually maintained all physician documentation updated, such as licenses, DEA

certificates, malpractice insurance and certifications.

Ensured all physicians were in compliance with hospitals board facility regulations. Responded

to requested inquiries from all healthcare organizations and hospitals. Assisted in retrieving and

solving any issues with patient insurance verifications and authorizations.

Acquired medical records from referring physicians from hospitals to input patient

demographics for office billing.

Created and maintained computerized record management systems to record and process data

maintaining confidentiality of all physician information.

Education

High School Diploma: 1996

Hialeah Miami Lakes High School

Certified Medical Assistant: 1997

Florida National College

Languages

English/Spanish

Accomplishments

Jump start Human Resources operations of startup multispecialty telemedicine company rendering services to

underserved patients in rural areas. Had the privilege to staff 80+ employees and create, establish and implement all policies and procedures for Human Resources Department.

References

References available upon request.



Contact this candidate