Jessica Montijo

Credentialing Specialist

Contact

*** *. ****** *****

Tucson, AZ 85706

520-***-****

ad15aa@r.postjobfree.com

Objective

As a Credentialing Specialist, my Objective is to ensure that medical staff members maintain current credentials to work legally in their chosen field and specialty.

Education

Chaparral College

BS Criminal Justice

GPA 2.5

University of Phoenix

Tucson, AZ 2011

MBA Business Administration

GPA 2.98

Key Skills

Credentialing Accreditation

Health Information Management

Microsoft Office 365

Google docs suite

Project Management

Database Management

Experience

June 2022-Current

Credentialing Specialist • OCHIN

Processing of initial Credentialing and Recredentialing applications in accordance with regulatory requirements (NCQA, HRSA/FTCA)

Credentialing and onboarding for new providers

Monitor applications and follow up as needed to resolve issues and discrepancies and obtain information from payors, providers, and other contacts, as necessary.

Set up and maintain provider information in online enrollment databases (CAQH, Silver Sheet.) and internal systems.

Maintain copies of current state licenses, certificates, DEA, malpractice coverage & other required credentialing documents for all providers.

Experience with payors in the following States: AZ, CO, OR, CA and WI

Experience with PECOS, PAVE, OR Health Authority, Forward Health WI and other payors within these States

Collect required documents from provider for HRSA credentialing.

June 2021-Current

Credentialing Specialist-Overcomers Counseling Inc. 1099 contractor employment

Process Initial and recredentialing applications for LCSW, LPC’s, and PMHNP for Payors in the State of Colorado (Aetna, Anthem, UCH, CO Medicaid, Evernorth, TriWest, Tricare West etc.

Update NPPPES, CAQH as required.

Respond to health plan provider inquiries.

Monitor Licenses and Credentials expiration dates. August 2017-May 2021

CARF International-Accreditation Specialist

•Developed project plans; coordinate projects; Communicate changes and progress, completes projects on time and within budget constraints, and manage project team activities.

•Provide specialized technical assistance to organizations about standards and accreditation process.

•Conduct crosswalks of accreditation standards and state regulations in development of public-private partnership as requested.

•Provide frequent customer contact with new and currently accredited organizations, interaction with surveyors and communication with others while focusing on customer satisfaction.

Support internal processes in new business- (Interactions with organizations about new business opportunities, gathered pertinent organizational details, enter data into account information management system (AIMS) and make updates at strategic business points to encourage market growth)

•Find and resolve problems accordingly and on time. La Frontera AZ, COPE Community Services

08/2007-08/2017

SMI Case Manager/Recovery Facilitator

Evaluate SMI patients with mental conditions and coordinate services and resources needed to meet their recovery goals.

Conduct full assessments and create recovery plans and crisis plans.

Perform home visits to evaluate patient’s progress.

Help patients identify and develop coping mechanisms.

Coordinated and monitored the patients use of services.

Attended meetings with other team members to coordinate and identify patients/member’s needs.

Communication

English/Spanish (Fluent)

Strong Oral and written communications

Proficient Computer Skills

Typing 40-55WPM

Great Customer Service skills

References- Available Upon Request

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