Data Entry Vice President
Resume:
************@*******.***
** ******** **. ********, ** 02126
ORTIZ
LESLIE
CREDENTIALING ADMINISTRATOR
EDUCATION
Data Entry/Computerized
Office Skill Training
Program
Jewish Vocational Service
Training Center, Boston,
MA
Five-month intensive
training program consisting
of: Microsoft Office 2000
Excel, Word and Access,
Data Entry, typing, filing,
Creating flyers and copying
EXPERIENCE
Massachusetts Behavioral Health Partnership, Boston, MA Credentialing Administrator
10/2015-04/2022
• Performed new credentialing and re-credentialing applications, ensuring accurate verification of provider’s primary source.
• Facilitated Local Credentialing Committee (LCC) Meetings, ensuring smooth and efficient process.
• Sent LCC letters promptly after the National Credentialing Committee (NCC) meetings.
• Updated and maintained LCC meeting minutes, ensuring accuracy and completeness.
• Scanned all documents to Network Connect, ensuring easy access and organization.
• Quality assured credentialing and re-credentialing applications, ensuring easy access and organization.
• Processed facility applications, preparing proposals for review and approval/denial by Regional Director and Director of Network Operations.
• Sent financial reports to MBHP CEO for review and evaluation.
• Verified licenses for contracted providers by checking OIG-licensure and OIG website, ensuring active status and no disciplinary actions or sanctions.
• Assisted provider with website registration forms to facilitate login access.
• Handled e-mails and high volume of calls from providers.
• Drafted e-mails to providers to request missing documents.
• Supported additional projects in the department.
• Sent weekly spreadsheet.
• Enrolled and dis-enrolled providers.
• Redacted documents as needed.
• Managed CAQH process.
• Prepared records for site visits and file audits.
• Perform other job related as dictated by business needs while displaying flexibility and a positive attitude.
Iglesias Eslabones Del Espíritu Inc., Boston, MA
Vice President Secretary/First Lady (Pastor)
07/13-Present
• Managed complex calendar and scheduling for Vice President, ensuring all appointments and meetings were organized and prioritized effectively.
• Coordinated travel arrangements, including booking flights, hotels, and transportation for Vice President's business trips.
• Prepared and edited correspondence, reports, and presentations for the Vice President, ensuring accuracy and professionalism in all documents.
• Facilitated communication between the Vice President and internal/external stakeholders, responding to inquiries and forwarding messages promptly and accurately.
• Maintained strict confidentiality and discretion in handling sensitive information and discussions involving the Vice President.
SUMMARY
Experienced Credentialing
Administrator with 6 years
of expertise managing and
maintaining the
credentialing process for
healthcare providers.
Skilled in verifying and
evaluating provider
credentials, collaborating
with internal stakeholders,
and developing
relationships with external
entities. Adept at
performing audits checks
to ensure data integrity
and adherence to
credentialing standards.
WORK EXPERIENCE (CONTINUED)
• Provided spiritual guidance and counseling to congregants.
• Delivered engaging and impactful sermons to inspire and motivate the congregation.
• Facilitated and organized religious ceremonies and sacraments, such as baptisms, weddings, and funerals.
• Developed and implemented outreach programs to foster community engagement and support.
• Managed and mentored a team of staff and volunteers to support various church ministries.
Massachusetts Behavioral Health Partnership, Boston, MA Claims Specialist
07/13-10/2015
• Process claims forms and reports.
• Analyze claims to determine extent of company’s liability, make approval or denial decisions.
• relationships with members and providers.
Massachusetts Behavioral Health Partnership, Boston, MA Engagement Specialist
09/12-07/13
• Answer phones and respond to customer requests.
• Provided accurate and appropriate information in response to customer inquiries.
• Maintaining strong communication skills (listening, written and verbal); built positive relationships with members and providers.
• Identify, research, and resolve customer issues using the computer system.
• Follow-up on customer inquiries not immediately resolved. Massachusetts Behavioral Health Partnership, Boston, MA Customer Service Rep II
09/11-09-12
• Handling behavioral service incoming/out calling calls.
• Address customer service inquiries in a timely and accurate fashion.
• Give accurate and appropriate information to answer questions, troubleshoot issues, and resolve complaints.
• Great communication with members and providers.
• Transfer customer calls to appropriate staff.
• Proven ability to manage multiple of different projects. Massachusetts Behavioral Health Partnership, Boston, MA Adjustment Fraud & Abuse
09/04-09/11
• Reversed and adjusted in-patient and out-patient claims.
• Assisted with the check-runs.
Massachusetts Behavioral Health Partnership, Boston, MA Data Entry
09/03-09/04
• Processed claims.
• Pulled claims for Alchemy software and burn CDs.
• Processed medical records.
• ESP special claims.
SKILLS
Database management
Multitasking
Communication
Effective Problem Solver
Strong Organizational
Skills
Detail-Oriented
Remote experience
Primary source verification
Data Integrity
LANGUAGE
English/Spanish
REFERENCES
Heaven Barros
Beacon Health Options
Adriana Mercado
Beacon Health Options
Richard Aaron
Beacon Health Options
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