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Credentialing Specialist

Mesa, AZ, 85201
January 04, 2020

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Adriana Vega

**** *. *** **. ****, AZ ***** 480-***-****


To obtain a position with a company that allows me to utilize my drive to support and improve the company’s growth.

Skill Highlights

4+ year of Medicaid and Medicare Experience

Bilingual (English and Spanish)

Reliable, Hard worker and energetic with excellent communication skills.

Ability to provide service in a quick and efficient manner

Ability to function independently with minimal supervision within the scope of knowledge and authority of the position

Detailed-Oriented with ability to enter information accurately on paper and electronic systems Work Experience

Case Coordinator 1/2019-To Present

American Behavioral Solutions, LLC – Mesa, AZ

Health Plan Denials

Health Plan Contracting

Prior Authorizations

Claim Status Follow ups

Provides administrative support and coordination for all aspects of patient care for both new and/or established patients

Assist with special projects as directed

Processing new hire paperwork

Screen applications/resume and setting up interviews

Complete verification of Eligibility for all referrals from patients

Processed and reviewed referrals from PCP for specialty and Ancillary care in a timely manner. Prioritizing the referrals according to defined levels of urgency. Speculation Member appointments as necessary and communication referral information to patients.

Credentialing Specialist 3/2016- to Present

Ventec Group, LLC – Mesa, Arizona

Initial credentialing applications submissions to AHCCCS and Private Insurances (Commercial) Including State Medicaid and Medicare Part B initial applications.

Contract Negations such as appeals, Reconsideration letters, Fee Schedules

Hospital Credentialing Services Privileges applications

Create Manuals, flow charts and other education material related to credentialing effort in the department

CAQH Set up and Re-Attested CAQH Profiles, Every 120 days

Re-Credentialing Management Services

Managed Contract Renewals Re-Credentials

Revalidation for Medicare Part B

Updated NPI, DEA and State License: Any Pay-to Address Updates, Primary Service Location

Insurance Updates/verifications of information and Network Participation, any new insurance that came out of the market we provided with information to see if the providers were interested in participating

Ongoing Customer Support: Answering any questions regarding credentialing, follow ups and participation for the office as needed.

Adriana Vega

1943 W. 2nd Pl. Mesa, AZ 85201 480-***-**** Assistant Manager 6/2012-3/2016

Dollar Tree, Mesa AZ

Responsible for assisting the Store Manager with day to day operational running of the store.

In charge of dealing with customer queries and managing stock levels

Processing of all required reports, documents and memos.

Protects and secures all company assets, including store cash.

Counting all the money at the end of the day, making a deposit.

Ring up merchandise items for customers, assist with answering incoming calls.

Balance out cash drawer at the end of every shift.

Notify CSR when its time to make a cash drop of larger bills.

Gained knowledge of all store products

Increased sales with excellent customer service level and developed good relations with regular customers.

Clothing Store Associate 1/2011-9/2011

BBB Fashion, Mesa AZ

Take inventory; prepare purchases for transportation by wrapping and bagging them.

Set up displays

Processing and re-stocking merchandise and keep a check on the floor stock

Perform responsibilities of cleaning the store to make it appear in an appealing presentable manner

Responsible for providing excellent customer service by offering ideas on the selection of clothing and accessories

Effective arrange and manage all clothes in the store. Education:

Dental Assisting 2010-2011

East Valley Institute of Technology (EVIT, Mesa AZ Earned HS Diploma 2007-2011

Westwood High School, Mesa AZ


Notary Public, State of AZ

Computer Skills:

Windows, Word, Excel, Internet

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