Magda I. Rios Email: adz0lt@r.postjobfree.com Mobile: 646-***-****

Professional Summary

Highly organized, accomplished and dedicated professional, equipped with broad based and extensive office management, administrative support, credential verification and analysis, as well as leadership expertise within the medical field, nursing homes, rehabilitations, and clinical settings. Show remarkable ability in providing high level administrative assistance utilizing comprehensive skills including validating credentials and qualifications. In search of a remote position only.

Skills

Rapid Conflict Resolution Adobe Acrobat Software

DocuSign Software CAQH Database

Provider Data Specialist Time Management & Prioritization Communication/Organizational Skills Microsoft Office (Word, Excel, Outlook Access), Web, and email Typing Speed 70 WPM Provider Data Management

Bullhorn Software Facets Software

Cactus Software MODIO Software

Administrative Assistant Customer Service

Provider Credentialing/Recredentialing

Experience:

Amazon Flex – Seffner, FL

Delivery Driver/Independent Contractor 12/2022 – Present

• Amazon flex delivery driver, saddled with responsibility of transporting and/or moving various items from Amazon production environments to a variety of customers in various locations. Aequors - Locum Connections – Piscataway, NJ 03/2022 07/2022 Credentialing Specialist/Administrative Assistant

• Provided Administrative back up for the Operations Department & Recruiters.

• Create providers profile, CV and perform Soft Verifications on providers contracted by Locums.

• Open job orders on Bullhorn, create job orders on BH attach all required documents.

• Post current openings on job boards (i.e., Doc Cafe, Hospitalist Working, Medworking, PA Job Sites, CRNA) for positions available for MD’s, DO’s, PA’s & NP’s.

• Create Booking forms for providers newly assigned, send to recruiters for presentations.

• Verify providers licensing on states they deem licensed.

• Track provider Time Sheets, file accordingly for payroll processing.

• Verify all providers work history via dashboard.

• Create DocuSign templates for provider contracts, pre credentialing documents, references.

• Provide administrative support to Operations Manager, Operations Administrator & Recruiters. Skylight Health Group Falls River, MA 06/2021 – 01/2022 Credentialing Specialist (temp)

• Performs primary source verification on new onboarding providers utilizing various verification methods, verifying elements such as, the professional licensing, training, and certifications of professional medical staff. Ensure healthcare professionals and services meet all established federal and state standards, as well as NCQA standards.

• Data entry of new applications in the credentialing software.

• Maintain the credentialing database and ensure up to date information is always obtained.

• Responsible for monitoring and managing credentialing/re credentialing requirements and to ensure the collection of all required renewal certifications are on file within the required time.

• Provide consistent and timely follow up on all outstanding credentialing/re credentialing.

• Prepare and scan credentialing/re credentialing files and other credentialing documentation.

• Answer credentialing telephone line and provide support to physicians, physician office staff, health plan contacts and company departments as necessary.

• Process provider demographic changes ensuring appropriate documentation has been submitted with the changes, update credentialing database.

• Process provider network terminations, specialty/category changes, leave of absence.

• Audit OIG reports, and other reports as required. NTT Data Services 01/2021 07/2021

Credentialing Specialist Remote

• Assist the plan in credentialing and re credentialing providers.

• Credential and re credential various providers, including physicians, healthcare delivery organizations, or pharmacies, according to applicable specifications.

• Maintain and update credentialing database.

• Assist with coordinating credentialing committee.

• Process, track, and file credentialing applications within established standards.

• Respond to internal and external customer inquiries regarding credentialing status. Affinity Health Plan Bronx, NY 04/2010 – 08/2018 Provider Data Specialist

• Maintain and support the functionality of the provider file which includes the provider application process, systems entry for all provider data, and resolution of provider issues.

• Ensure the quality of provider data as it relates to additions, modifications, and deletions.

• Review and analyze individual provider issues originating from various sources.

• Identify and implement appropriate resolution based on analysis.

• Successfully execute system updates for PCP terminations & Initial Applications.

• Assign, create & process Footprints for PDM.

• Develop, document, and implement new procedures affecting the business environment as it relates to provider records and provider information processing.

• Manager provides special projects which consist of updating all provider files in a timely fashion.

• Maintain and support the functionality of Alturista and its requests for updates, including creating FP and updating provider group & provider records.

• Re credentialing – CPAC and/or CMO updates Maintain & ensure the accuracy of provider records and their credentials, using Cactus & Facets.

• Research demographics on websites (i.e., NPPES, NYS, NYSED) & web.

• Maintain & successfully enter Delegated Submissions (Adds & Updates, terms).

• Clean Up & Updates of provider records, including groups and facilities.

• Create, maintain, and support all Faxcom requests including creating footprints, verifying demographics, licenses, and boards, and updating records.

• Maintain all Non Par records, including entries, updates, and terminations.

• Delegated Submissions – Provide accurate loading of providers for Hospital Entities contracted w/Affinity.

*References upon request

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