Follow Up Customer Service

Adela M. Hernandez

**** *** ****** **, #* Universal City, TX 78148

726-***-**** cell *******@*****.***

Career Objective

I want to succeed in a stimulating and challenging environment, building the success of the company while I experience advancement opportunities.

Work Experience

National Integrated Healthcare Group November 2022- March 2024

539 W. Commerce, Ste 1140, Dallas, TX 75208 817-***-****

Title: Credentialing Manager

Duties: Prepare and maintain credentialing files and reports for all individual providers including maintenance of credentialing software (MD Staff and Google Docs), provider rosters and spreadsheets to comply with group delegation requirements. Process and file applications with third party payors according to each payors individual requirements and addresses/corrects discrepancies as requested by payors. Conduct all follow up steps till payor approval/completion is obtained. File provider practice change notifications and perform follow up duties till confirmed complete by payers. Update NPI records according to provider specifications. Enroll providers in Medicare/Medicaid as prescribed by each program requirements. Track provider licensure and Board expirations and ensure timely processing CAQH, TMHP and payor updates. Complete requests for re-credentialing for both providers and facilities. Accept and process all requests from payers for credentialing information/updates/new contracts and products Answer questions, process requests from staff/providers related to credentialing information. Prepare and maintain facility credentialing files and reports including maintenance of credentialing software, facility rosters and spreadsheets. Ensure all records meet standards set by carriers as well as FQHC guidelines. Enrolls facilities in Medicare/Medicaid programs. Address enrollment disconnects in regards to facilities and providers. Assist with EHRS enrollment, tracking and filing. Maintains quarterly payor specific rosters in accordance to CMS standards. Assist in quarterly CAQH mass attestation. Serves as liaison between Legacy and outside organizations and external customers. Participates in the Performance Improvement Program. Also audit team members and train where needed.

GiaMedJV (formerly MedTrust, LLC) October 2014- July 2022

6245 N. Federal Highway, STE 201, Fort Lauderdale, FL 210-***-****

Title: Credentialing Specialist

Duties: Analyzes and extrapolates contract requirements based on analysis of contract to compile credentialing checklist. Reviews credentialing applications, conduct follow-up to obtain missing credentials/information, conduct verifications, create provider credentialing records within CCQAS and maintain the CCQAS record. Performs primary source verification, credential collection, data interpretation and review, follow up, and enters credentialing data into specified systems. Manages the initial credentialing process by designating timelines and requirements to the candidates. Assists them with questions and locating resources in their area for obtaining requirements when applicable. Serve as liaison between the employees and operations to ensure that all credentials and training are current and credentialing files are complete. Maintains communication with personnel on an on-going basis with information on expiring credentials and training. Works with candidates and field employees to acquire timely delivery of all necessary credentialing requirements and updated certifications, licenses, and immunizations. Manages required reporting on expiring credentials and compliance status for all assigned employees. Contacts employees using multiple means of communication to obtain new credentials before expiration following established protocol. Works to ensure no employee is pulled from schedule due to expired credentials. Works to ensure that expiration does not exceed established protocol and no employee is pulled from schedule. Completes candidate credential files to be compliant with client and company specific standards. Created Relias platform and completed migration. Created CITRIX Sharefile platform and rolled out for use.

Walgreens February 2016-October 2022

10411 West Avenue, San Antonio 210-***-****

Title: Customer Service Associate/Cashier

Duties : provide translation for pharmacy medications, as needed. Registers sales on assigned cash register, provides customers with courteous, fair, friendly, and efficient checkout service.Customer Experience. Engages customers and patients by greeting them and offering assistance with products and services. Resolves customer issues and answers questions to ensure a positive customer experience. Models and shares customer service best practices with all team members to deliver a distinctive and delightful customer experience, including interpersonal habits (e.g., greeting, eye contact, courtesy, etc.) and Walgreens service traits (e.g., offering help proactively, identifying needs, servicing until satisfied, etc.). For consumable items, assists in stock rotation, using the first in, first out method and restock outs. Has working knowledge of store systems and store equipment. Provides customer service in the photo area, including digital passport photo service, poster print and creative machine, suggestive sell of promotional photo products. Assumes web pick-up responsibilities (monitors orders in Picture Care Plus, fills orders (pick items), delivers orders to customers as they arrive at store). Assists with exterior and interior maintenance by ensuring clean, neat, orderly store condition and appearance. Complies with all company policies and procedures; maintains respectful relationships with coworkers. Completes special assignments and other tasks as assigned.Training & Personal Development Attends training and completes PPLs requested by Manager or assigned by corporate.

STS Technical Services through Officeteam, Robert Half April 2013 – June 2013

9901 IH 10 West, Suite 230, San Antonio, TX 210-***-****

Title: Receptionist

Duties: Answer all incoming calls. Order and keep track of all office supply orders and needs. Meet and greet all outside correspondence in a courteous and attentive manner. Duties also assigned by immediate manager.

USAA through Officeteam, Robert Half November 2012 – February 2013

9901 IH 10 West, Suite 230, San Antonio, TX 210-***-****

Title: Executive Associate

Duties: As assigned by AVP. Time keeper for 3rd Party and FTE employees. . Maintain schedule

and agendas for Vice President, all Department Directors and Managers. Filing, typing correspondence,

order and maintain records of all supplies for the company. Maintain correspondence for 3rd party offshore

employees and provide cell phones, VPN access as needed by 3rd Party. Code and approve Corporate

Credit Card usage. Point of contact for potential interoffice moves or reconfigurations. Maintain all

offshore travel correspondence and schedule VISA’s, setup travel for the entire department. In charge of all

monthly executive initiatives, objectives, and Weekly Activity Report (WAR) submissions.

Baptist Health System June 2011 – June 2012

19026 Stone Oak Pkwy, Suite 215, San Antonio, TX 78258 210-***-****

Title: Provider Relations Representative

Duties: Recruits new physicians and other providers as needed. Negotiates contracts and letters

of agreement with providers. Educates providers and their office staff. Visits with Primary Care Physicians’ office staff on a monthly basis. Visits with Specialty Care Physicians’ office staff on a bi-annually basis. Provides ongoing service/problem solving assistance to all providers as needed. Ensures all providers are updated on newly revised policies and procedures. Assists in the development of training manuals and provider directories for distribution to all provider offices. Works closely with other departments in order to facilitate prompt resolution to various provider issues. Utilizes resources efficiently and effectively. Maintains a safe environment. Participates in Performance Improvement activities.

Baptist Health System June 2005 – June 2011

19026 Stone Oak Pkwy, Suite 215, San Antonio, TX 78258 210-***-****

Title: Executive Assistant

Duties: As assigned by Vice President’s. Maintain schedule and agendas for Vice President of

Managed Care, Vice President of Finance and Vice President of Material’s Management, as well as prepare for upcoming meetings, to include minutes for meetings held. Filing, typing correspondence and order and maintain records of all supplies for the company. Also generate invoices, follow-up with collection

letters/calls, etc for all Outreach Labs facilities in San Antonio, generate check requests for all Collection

agencies. When needed look up payments for Accounts Payable, Patient information and Insurance

coverage. Maintain time cards for all of Managed Care department, as well as keep minutes for Finance

and Managed Care Monthly meetings. I sit on Regional People Team Board, Office Party Committee and

take care of all issues pertaining to building maintenance and parking issues.

Rackspace June 2008 – October 2008

9725 Datapoint, Suite 100, San Antonio, TX 78229 210-***-****

Title: Administrative Assistant II

Duties: Assist as needed in Managed Department, to include Network Support, Linux Teams and

Windows Teams. Filing, typing correspondence and order and maintain records of all supplies for the company. Maintain time cards for Team Leads and Vice President, as well as keep minutes for meetings. I sit on the Office Party Committee and take care of all issues between different shifts and Leads.

The Children’s Shelter June 2004 – November 2004

2939 W. Woodlawn, San Antonio, TX 78228 210-***-****

Title: Administrative Assistant

Duties: As assigned by the President/CEO. Backup relief for other departments, maintain tours and

speeches schedule for the company, answer all incoming calls and transfer calls where appropriate. Maintain schedule and agendas for President/CEO, as well as prepare for upcoming meetings, as well as keep minutes for all meetings. Set up and maintain email distribution, data entry, accounts receivable, log in and copy checks, grants, etc., filing typing correspondence and order and maintain records of all supplies for company.

Diabetes & Glandular Disease Clinic and Research Associates June 1999 – June 2004

5107 Medical Drive San Antonio, TX 78229 210-***-****

Title: Administrative Aide/Clerk/Assistant

Duties: Credentialing for physicians, maintaining Clinic website, travel arrangements for physicians, all physician emailing, maintaining correspondence with attorneys for physicians, answer all incoming calls for physicians and administrator, personal assistant to administrator, work given as needed, maintain company telephone system and resolve all telephone problems, maintain records for security and parking, maintain correspondence and job function for maintenance and housekeeping for building, maintain all written records of published articles for physicians, type and record all physician patient terminations, assist with all current events, coordinate and assist with all company functions and process all data, make all presentations for physicians, copy and distribute all monthly financial statements, as well as make low charts for financials, fill in for clinic positions as needed to include, phlebotomy, check in/check out, posting money and procedures, insurance verification, referral verification, mail distribution, filing and transcriptions.

Education

Texas Careers (Medical Office Assistant) Graduated August 1997

National Institute of Technology (Medical Assistant) Graduated January 1995

Edison High School Graduated June 1990

Certifications

Cyber Awareness Challenge

DOD - 2024

Identifying and Safeguarding Personally Identifiable Information (PII)

DOD - 2024

Phishing Awareness

DOD - 2024

Social Networking and Your Online Identity

DOD - 2024

Cyber Law

DOD - 2023-2024

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