To obtain a position with a company that allows me to utilize my drive to support and improve the company’s growth.
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
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.
1943 W. 2nd Pl. Mesa, AZ 85201 480-***-**** email@example.com 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
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