Quality Assurance Customer Service
Resume:
Patricia Cardinal
***** ****** * ******* ** #2102
**********@*****.***
Objective I am a goal oriented front line manager with 6+
years of proven success in
healthcare credentialing, quality assurance
operations, and managing staff, seeking to secure a
position utilizing my extensive knowledge of the
healthcare field to become part of a team in a
fast-paced managed care organization.
Professional Accomplishments
Provider Relations/Credentialing/Contracting
. Over 6 years of experience in healthcare
credentialing
. Management experience
. Complex problem resolution; both members and
providers
. Involved in updates to Provider Relations and
Billing Policy and Procedures
. Able to flow between Member/Provider and
Contracting/Billing/Credentialing dynamics for
optimal results
. Enhanced and expanded Network Development
processes; Physician Recruitment
. Coached, Trained and Oversight of 6+ staff
members in both Provider Relations and Billing,
. Superior oral and written communication abilities
Work with minimal supervision
Developed and implemented provider and facility
site visit procedures
Professional Skills
. Computer literate (MS Word, Excel, PowerPoint,
Access)
. Master Negotiator
. Project driven, Quality Assurance
. Managed Care
. Billing/Claims resolution
. Customer Service Professional
Work experience 08/2013 - present Diabetes America
Houston TX
Credentialing Supervisor/Contract Specialist
Supervise Credentialing Staff
Managed Care Contract Management; tracking of fee
schedules, Maintained database of PPO, POS, HMO,
FFS, Contracts
Processed credentialing/re-credentialing files
according to all accrediting and regulatory
agencies.
Initial and subsequent credentialing to health plan
carriers
Initial and subsequent training of staff
Medicare PECOS Enrollment, CAQH
Resolved credentialing and contracting issues
Chaired department/interdepartmental meetings
Generated weekly reports to track initial
credentialing due dates.
Other credentialing related duties as assigned by
the management team
Local and regional travel
06/ 2007-08/2013 Interface EAP
Houston TX
Provider Relations Senior Associate - Team Leader
Supervised staff in Provider Relations and Billing
Departments
Process and troubleshoot EAP bills and managed care
claims
Maintain provider and facility databases; provider
and facility negotiations and contracting
Recruited and negotiated facility contracts
Provider and facility initial credentialing and
re-credentialing processes
Quality assurance activities utilizing the PDCA
cycle, developed a Quality Assurance program
(Performance Improvement Initiative) for the
Operations Department
Regional and local travel for Network Development
Recruited providers for Network Expansion
Project driven- determining areas of improvement
and oversee project development
Worked with management approval to update
departmental Policy and Procedures
03/ 2006-06/ 2007 United Recovery Systems Houston
TX
Professional Debt Collector
Negotiated settlements for charged off and
pre-charged off debt
Educated consumers on credit issues and trained new
debt collectors
11/2000-10/2005 MD Anderson Cancer Center Houston
TX
Patient Services Coordinator
Interpreted and coordinated physicians' orders to
schedule diagnostic tests.
Trained new Patient Services Coordinators
Worked with other departments to coordinate patient
schedules/resolved difficult scheduling issues
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