Carlene M. Santiago

**** ******** ****** ***** ***. 304

Columbia Maryland 21045

adykh1@r.postjobfree.com

Mobile 443-***-****

OBJECTIVE

A self-motivated, team-oriented health care professional with over 10 years’ experience in the private sector. A history of accuracy, timely follow through and compliance to regulatory guidelines. Flexible in the constantly changing health care landscape and versatile in an inpatient and outpatient setting. A poised and competent leader with demonstrated abilities to easily transcend culturally diverse environments. Thrives in deadline-driven team situations with tested leadership skills. SUMMARY OF QUALIFICATIONS

• Experience with a variety of EMR Systems

• Effective communication skills

• Proficient with various medical terminology

• Proficient with Microsoft Word, Excel and PowerPoint

• Highly skilled in customer support, customer care, client relations and support services

EXPERIENCE

• CareFirst BlueCross Blue Shield

• Provider Credentialing Analyst July 2022-Present Columbia, MD

• Analyzes and researches credentialing application/provider contracts to verify that appropriate

• Information has been obtained as well as handles incoming and outgoing correspondence

• Regarding the applications determines the appropriate network for participating and obtains the

• Appropriate executed contracts. Maintains the on-line provider file and hardcopy file with

• Updated provider information-Credentials and re-credentials providers to appropriate levels.

• Maintains the Application log in accordance with the state legislation.

• Heritage Harbor Health and Rehabilitation August 2011- Present Annapolis, MD

• Health Information Coordinator

• Overseen training, operations and retention of qualified staff in themedical records staff, receptionists and unit secretaries

• Process-based management of sensitive patient information, physician’s order and visit schedule

• Maintains records and completes required forms and documents in accordance with company policy as well as state and federal regulations.

• Mentoring other facilities medical record coordinators to ensure the companies correct policies and procedures regarding the Medical Record Department.

• Proficient in Curaspan, Durado Verification system, and RTT programs

• Responsible for credentialing all Providers

• Assisted with admission department with new admission process.

• FutureCare Irvington June 2008 – February 2011 Baltimore, MD

• Medical Records Coordinator

• Process-based management of sensitive patient information, physician’s order and visit schedule

• Maintains records and completes required forms and documents in accordance with company policy as well as state and federal regulations.

• HCR Manor Care November 2005-June 2008 Catonsville, MD

• Medical Records Coordinator

• Process-based management of sensitive patient information, physician’s order and visit schedule

• Maintains records and completes required forms and documents in accordance with company policy as well as state and federal regulations.

• Work with nursing to ensure accuracy of documentation.

• Assisted in efficiently completing the discharge process bycoordinating with staff and physicians on meeting deadlines.

• Aetna US Healthcare November 1998 – November 2001 Largo, MD Member Service Professional

• Handled time sensitive simple to complex task from customers ranging from members, providers and employer offices.

• Initiated and monitored claim discrepancies as well as member case appeals to ensure timely resolution.

• Maintained reference material, company procedures and benefit changes for new or existing accounts.

• Demonstrated excellent verbal and written communication with outside vendors to coordinate benefits and services. ACHIEVEMENTS:

• Employee of the Month – December 2008

• Nominee for Employee of the Year 2008, 2010

• Outstanding Customer Service Award 2018

EDUCATION:

• Howard Community College – Columbia, MD; Computer medical billing & coding certification 2004-2005

• ICD-10 Training

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