Credentialing Specialist

Location:

Miami, FL

Salary:

20.00 per hour

Posted:

January 09, 2023

Contact this candidate

Resume:

Resume for Rachel Lauzurique

*** ********* ******

Unit 3

Coral Gables Fl 33134

Email: ************@*****.***

Cell: 305-***-****

Excellent communicator, customer, and interpersonal skills. Ability to use phone and computer systems, with written interaction skills, strong listening/comprehension abilities, Competence to stay composed under stressful situations with a cheerful outlook while providing quality and professional customer service that consistently meets or exceeds Company standards of excellence and customer expectations. Meticulous in her job performance. Interested in a long-term position with a reputable institution. Fluently bilingual-English and Spanish -Spoken and written. Microsoft Word, Excel, MD Staff and Cactus. Vast knowledge of NCQA, AHCA, CMS, JCAHO, working with a CVO.

WILL WORK REMOTE

Self Employed. Translator of legal documents (English to Spanish and Spanish to English), Notary Public, drafting of affidavits etc.

April 2020 to present

Experienced senior credentialing manager

1.Doctors Health Care Inc

Dates Employed: August 2019 to March 2020

Address: 2020 Ponce de Leon Blvd, PH1, Coral Gables, FL 33134

For references: Regis HRG

Tel; 786-***-****

Reconcile information provided by medical personnel and upload lengthy information on data bank.

Audit and verify that all information provided is accurate versus government web sites

Responsible for credentialing new and established health care providers and maintenance of information to include assisting client facilities with primary source verification follow up, data collection, data entry, and document review.

Promptly and efficiently answer all phone and email inquiries from providers

Maintains the credentialing database and tracks all direct provider contract data.

Coordination of credentialing and re-credentialing activities of each provider according to program policy.

Enters all credentialing information into credentialing module and submits for credentialing.

Prepares files for presentation to the Chief Medical Officer and Credentialing Committee

Coordinates and communicates activities with the Credentialing Committee.

Prepares and distributes minutes to Credentialing Committee members and other internal staff.

Activates and deactivates direct contracted providers in the provider database.

Performance of primary and secondary verification sources of credentials according to departmental policy.

Assistance in auditing delegated credentialing functions in accordance with policies and procedures.

Notification to Network Services Representatives when unable to obtain required documentation.

Audits files for completed information upon submission, requests missing data from providers.

Adheres to the policies and procedures of the company.

Maintains strict confidentiality of client, company, and personnel information.

Demonstrates a strong commitment to the mission and values of the organization.

Adheres to company attendance standards.

Draft correspondence in English and Spanish as requested

2.Credentialing Senior Analyst of the re-credentialing Department.

Jackson Health Systems/Jackson Memorial Hospital

Dates Employed: Aug 2015 – July 2019

Location Human Resources: 1500 N.W. 12th Avenue, 1st Floor, Suite 106

Miami, FL 33136

Office: 305-***-**** press #1 -Human Resources Department employment verification

Fax: 305-***-****-Human Resources Department

Reconcile information provided by medical personnel and upload lengthy information on data bank.

Audit and verify that all information provided is accurate versus government web sites

Promptly and efficiently answer all phone and email inquiries from providers

Responsible for the supervision of four associates in the re-credentialing department including new and established health care providers and maintenance of information to include assisting client facilities with primary source verification follow up, data collection, data entry, and document review.

Maintains the credentialing database and tracks all direct provider contract data.

Coordination of credentialing and re-credentialing activities of each provider according to program policy.

Enters all credentialing information into credentialing module and submits for credentialing.

Verified all files for presentation to the Chief Medical Officer and Credentialing Committee.

Made verbal and written presentation to the Chief Medical Officer and Credentialing Committee

Coordinates and communicates activities with the Credentialing Committee.

Prepares and distributes minutes to Credentialing Committee members and other internal staff.

Activates and deactivates direct contracted providers in the provider database.

Performance of primary and secondary verifications sources of credentials according to departmental policy.

Assistance in auditing delegated credentialing functions in accordance with policies and procedures.

Notification to Network Services Representatives when unable to obtain required documentation.

Audits files for completed information upon submission, requests missing data from providers.

Adheres to the policies and procedures of JMH

Maintains strict confidentiality of client, company and personnel information

Demonstrates a strong commitment to the mission and values of the organization

Adheres to company attendance standards

Performs other duties as assigned

1.Credentialing Specialist

VITAS Healthcare

Dates Employed: Nov 2013 – Jul 2015

For References: 201 Biscayne Blvd, Suite 400, Miami Fl 33131

Tel; 305-***-****

Contact: Human Resources

Reconcile information provided by medical personnel and upload lengthy information on data bank.

Audit and verify that all information provided is accurate versus government web sites

Promptly and efficiently answer all phone and email inquiries from providers

Maintains the credentialing database and tracks all direct provider contract data.

Coordination of credentialing and re-credentialing activities of each provider according to program policy.

Enters all credentialing information into credentialing module and submits for credentialing.

Prepares files for presentation to the Chief Medical Officer and Credentialing Committee.

Coordinates and communicates activities with the Credentialing Committee.

Prepares and distributes minutes to Credentialing Committee members and other internal staff.

Activates and deactivates direct contracted providers in the provider database.

Performance of primary and secondary verifications sources of credentials according to departmental policy.

Assistance in auditing delegated credentialing functions in accordance with policies and procedures.

Notification to Network Services Representatives when unable to obtain required documentation.

Audits files for completed information upon submission, requests missing data from providers.

Adheres to the policies and procedures of Vitas

Maintains strict confidentiality of client, company and personnel information

Demonstrates a strong commitment to the mission and values of the organization

Adheres to company attendance standards

3.Credentialing Manager/ Administrative Assistant to the Director

Miami Jewish Health Systems Community Service Division.

Dates Employed: Nov 2009 – Nov 2013

For References: 5200 NE 2 Avenue, Miami FL 33137

Tel; 305-***-****

Reconcile information provided by medical personnel and upload lengthy information on data bank.

Audit and verify that all information provided is accurate versus government web sites

Responsible for the maintenance and process of a comprehensive credentialing and re-credentialing process with well-defined policies, procedures, criteria supporting data used to evaluate the providers who service our elderly clientele.

Promptly and efficiently answer all phone and email inquiries from providers

Assistance with the coordination of credentialing committee meetings.

Prepares verification letters.

Maintenance of credentialing files, both in paper and digital format.

Coordinates and expedites the flow of a quality credentialing process which includes a series of activities designed to collect and verify relevant data that will serve as the basis for decision regarding:

Appointments/reappointments to the provider network.

Collaborates with administrative offices, Finance & Budgeting, Legal Counsel, on site audits, provider directories in coordination of the credentialing process.

Contract management, i.e., preparation, maintenance, and revision of contracts for approximately 400 subcontracted providers, comprising of two community outreach programs.

Tracks credential expiration dates and secures updated documents Participates in weekly staff meetings, providing credential expiration and compliance updates Interacting with providers, including monitoring activities for credentialing and re-credentialing of contacts.

Enters data regarding credential expirations into system of record

Translations of documents English/Spanish and vice versa

Drafting of correspondence on a given topic for management including mail Mergers

Produces quarterly reports as requested

Arrange all travel related activities including air reservations, hotel, cars, event catering etc

Obtain and process Fingerprints for care givers via the Department of Elder Affairs.

Education

Garces Commercial College, Miami Fl

Degree: Bachelor of Business Administration (B.B.A.)

Field of Study Business Administration and Management, General

Dates attended 1980 – 1983 graduated Cum Laude.

Notary Public State of Florida. Licensed, bonded and insured.