Credentialing Coordinator
Resume:
Experienced Credentialing Specialist adept at
conducting application reviews and primary
source verifications. Excellent relationship-building, problem-solving and communication skills.
Experienced administrative professional with 14+
years in provider credentialing services. Works
productively with facilities, provider groups and
individual professionals. Knowledgeable about
application requirements for government and
private insurance plans. Collaborative leader with dedication to partnering with coworkers to
promote engaged, empowering work culture.
Documented strengths in building and maintaining
relationships with diverse range of stakeholders in dynamic, fast-paced settings.
PROFESSIONAL SUMMARY
CDSS - IHSS Care Provider
Atwater, CA • 03/2022 - Current
WORK HISTORY
Provided mobility assistance such as walking and
regular exercising.
•
Traveled to clients' homes to complete
healthcare services and promote continuity of
care.
•
Offered patients and families emotional support
and instruction in preparing healthy meals,
independent living and adaptation to disability
or illness.
•
Coordinated daily medicine schedules and
administration to help clients address symptoms
and enhance quality of life.
•
Assisted patients with dressing, grooming and
feeding needs, helping to overcome and adapt
•
SKILLS
• Office management
• Clerical duties
• Training and mentoring
• Administrative support
• Registration processing
• Problem-solving skills
• Decision-Making Abilities
• Oral and written communications
• Staff Management
• Provider enrollment
Accreditation information
management
•
• Insurance credentialing processes
• Pre-Employment Screening
• Contract Negotiation
• File and records management
• Provider Relations
• Visual prescreening
• Chart documentation
• Appointment Scheduling
• Medical history documentation
• Conflict resolution
• Microsoft Office
• Flexible & Adaptable
• Office administration
• Documentation and reporting
• Customer service
• Medical billing code accuracy
• Nextech EMR
Chapman-Hettinga Adult Center
Garden Grove, CA • 05/2007
EDUCATION
KARLA BATRES E: ************@*******.***
P: 323-***-****
A: Whittier, CA 90606
QueensCare Health Centers - Administrative
Assistant/Credentialing
City Of Los Angeles, CA • 08/2021 - 02/2022
to mobility restrictions.
Encouraged patients to participate in safe
physical activity to help boost mood and
improve overall wellness.
•
Followed nutritional plans to prepare optimal
meals.
•
Provided transportation and appointments
management.
•
Provided compassionate and patient-focused
care to cultivate well-being.
•
Scheduled daily and weekly care hours for client
caseload.
•
Cooked meals and assisted patients with eating
tasks to support healthy nutrition.
•
Supported daily hygiene needs of patients by
assisting with bathing, dressing, dental care and
personal grooming.
•
Built and maintained rapport with clients and
family members to facilitate trusting caregiver
relationship.
•
Laundered items, changed sheets and made
bed to keep patients' bedroom clean.
•
Transported clients to and from medical
appointments with safety and efficiency.
•
Assisted with daily living activities, running errands and household chores.
•
Entrusted to handle confidential and sensitive
situations in professional matter.
•
Communicated effectively with various parties
each day using polished interpersonal and
active listening skills.
•
Tracked expiration dates on documents and
communicated with appropriate staff to avoid
late filing.
•
Worked closely with practitioners to help each
obtain privileges at assigned healthcare facilities
•
Assisted with managed care auditing processes
and performed internal file audits.
•
Maintained accurate files, records and
credentialing documents in well-maintained
•
GED
American Career College
Anaheim, CA • 04/2007
Medical Billing/Coding
Coastal Vision Medical Group - Front Desk
Manager/Credentialing Specialist
Long Beach, CA • 06/2006 - 03/2020
databases using Software.
Received and evaluated applications to look for
missing and inaccurate information.
•
Conducted primary source verifications such as
background checks and board certifications.
•
Enrolled providers and Medicaid, Medicare and
private insurance plans.
•
• Prepared records for site visits and file audits. Partnered with departmental managers to
ascertain hiring needs and subsequently provide
candidate recommendations.
•
Improved office efficiency by effectively
managing internal communications and
correspondence.
•
Created, prepared and delivered reports to
various departments.
•
Improved organizational filing systems for
confidential employee records, resulting in
improved accessibility and efficiency.
•
Defined clear targets and objectives and
communicated to other team members.
•
Investigated locations to confirm license data,
conducted background checked and assessed
premises for compliance with licensing
requirements.
•
Entered into record-keeping systems appropriate
data needed to create new records or update
existing ones.
•
Managed team of employees, overseeing hiring,
training and professional growth of employees.
•
Completed human resource operational
requirements by scheduling and assigning
employees.
•
Proved successful working within tight deadlines
and fast-paced atmosphere.
•
Participated in team-building activities to
enhance working relationships.
•
Used computer programs and registration
systems to schedule patients for routine and
complex procedures.
•
Coordinated patient scheduling, check-in,
check-out and payments for billing.
•
Checked patient data including insurance,
demographic and health history to keep
information current.
•
Used computerized data management systems
to organize immense datasets and coordinate
care details for large patient bases.
•
Remained aware of provider schedules and
scope of practice on evolving basis to organize
and schedule appropriate care.
•
Fielded concerns surrounding patients and care,
liaising between physician, patient and
insurance company.
•
Offered ample support to team members with
creative solutions to complex challenges
regarding scheduling, conflict resolution and
medical care.
•
Helped patients complete necessary medical
forms and documentation.
•
Adhered to strict HIPAA guidelines to protect
patient privacy.
•
Organized paperwork such as charts and reports
for office and patient needs.
•
Kept waiting room neat and organized by
stacking magazines, removing trash and
cleaning glass.
•
Enhanced office productivity by handling high
volume of callers per day.
•
Completed patient referrals to other medical
specialists.
•
Supported office staff and operational
requirements with administrative tasks.
•
Contributed to and helped lead employee staff
meetings, reporting trends in procedures,
advising leadership on resources needed and
preparing information to be disseminated.
•
Handled customer complaints, resolved issues
and adjusted policies to meet changing needs.
•
Interviewed, hired and trained new employees
for production positions.
•
Evaluated employee performance and
coached and trained to improve weak areas.
•
• Provided supportive link between external
customers and internal operations.
Operated ophthalmic equipment for patient eye
examinations and prepared patients for
examinations and surgeries.
•
Explained pre- and post-operative procedures to
patients and carefully reviewed surgical plans.
•
Adjusted fit and conducted minor repairs to
eyeglasses as part of patient fit process.
•
Measured corneal curvature using keratometer
to determine axis and extent of astigmatism.
•
Used Lensometer to measure and record lens
power of existing prescriptive spectacles.
•
Conducted corneal pachymetry as screening for
Keratoconus, LRI surgery and glaucoma.
•
Measured intraocular pressure using Goldman
and Tonopen tonometry process.
•
Instructed patient in care of use of various types of contact lenses, demonstrating insertion,
removal and cleaning.
•
Measured and recorded visual acuity and color
vision testing.
•
Triaged phone calls from patients and outside
contacts and handled in order of importance.
•
Instilled anesthetic drops and assisted in laser
treatments and minor procedures.
•
Conducted Goldman and Humphrey Visual Field
Testing as part of overall vision evaluation.
•
Assessed patients for eye issues and checked
visual acuity, color plates and papillary function.
•
Worked well with patients, staff and
manufacturer representatives to carry out
successful office- and patient-related work each
day.
•
Identified issues during preliminary exam and
addressed concerns with physician.
•
Provided patients with detailed instructions for
pre- and post-op care under physician
supervision to promote healing and optimal
recovery strategies.
•
Directed patients to exam rooms for initial
evaluations and intake, including history,
medication and symptom documentation, to
aide physicians with carrying out efficient
appointments.
•
Conducted primary source verifications such as
background checks and board certifications.
•
Received and evaluated applications to look for
missing and inaccurate information.
•
Enrolled providers and Medicaid, Medicare and
private insurance plans.
•
• Prepared records for site visits and file audits. Improved office efficiency by effectively
managing internal communications and
correspondence.
•
Acted as staff member advocate, encouraging
and supporting Managements to identify and
resolve conflicts.
•
Communicated effectively with various parties
each day using polished interpersonal and
active listening skills.
•
Tracked expiration dates on documents and
communicated with appropriate staff to avoid
late filing.
•
Maintained accurate files, records and
credentialing documents in well-maintained
databases.
•
Worked closely with practitioners to help each
obtain privileges at assigned healthcare facilities.
•
Pre-screened resumes prior to sending to
corporate hiring managers for consideration.
•
Effectively supervised staff of six personnel by
implementing company policies, protocols, work
rules and disciplinary action.
•
Maintained professional demeanor by staying
calm when addressing unhappy or angry
customers.
•
Maintained positive customer relations by
addressing problems head-on and implementing
successful corrective actions.
•
Initiated follow-up communications required to
adequately research and secure information
necessary to facilitate credentialing goals.
•
Maintained strict confidentiality with regard to
protected health information.
•
Served as resource for physicians in credentialing and privileging process.
•
Maintained current knowledge of medical staff
bylaws, rules and regulations, policies and
•
procedures and credentialing requirements.
Maintained consistent follow-up on status of prior authorization requests.
•
Submitted for prior authorization with required
documentation to appropriate funding source.
•
Reviewed documentation for accuracy and
assessment of necessity.
•
Gathered records pertinent to specific problems,
reviewed for completeness and accuracy and
attached records to correspondence as
necessary.
•
Triaged unscheduled and emergency
authorizations, directing submissions to
appropriate personnel for rapid response.
•
Obtained payments from patients and scanned
identification and insurance cards.
•
Frequently double-checked patient histories and
current information while scheduling follow-ups
and other appointments.
•
Contacted hospitals to confirm patients medical
histories and prevent inaccurate diagnoses and
treatments.
•
Managed office logistics by scheduling
appointments, maintaining files and collecting
payments.
•
Verified eligibility and compliance with
authorization requirements for service providers.
•
Confirmed appointments, communicated with
clients and updated client records.
•
• Resolved customer problems and complaints.
Managed multiple tasks and met time-sensitive
deadlines.
•
Reached out to insurance carriers to obtain prior
authorization for testing and procedures.
•
LANGUAGES
Spanish
Full Professional
Contact this candidate