Credentialing Specialist Enrollment
Resume:
TAYSHA RIVERA MONTERO
PROFESSIONAL SUMMARY
Detail-oriented Credentialing and Enrollment Specialist with over 6 years of experience in managing credentialing processes for healthcare providers. Adept at ensuring compliance with accreditation standards, performing primary source verifications, and maintaining accurate documentation. Seeking to apply my expertise in credentialing and enrollment to contribute to the operational success and integrity of a dynamic healthcare organization.
SKILLS
Credentialing & Enrollment
Management
• • Compliance & Regulatory Knowledge
• Primary Source Verification • CAQH & NPI Management
• Microsoft Word, Excel, Teams • Detail-Oriented & Organized
• Leadership & Team Collaboration • Problem-Solving & Critical Thinking Ability to Work Under Pressure & Meet
Deadlines
•
WORK HISTORY
July 2024 - Current
Watson Clinic- Hybrid - Provider Enrollment/Credentialing Specialist, Lakeland, FL Spearhead the full licensing process for healthcare providers, with a strong focus on Medicare/Medicaid applications, NPI updates, surrogacy documentation, diabetes letters, and state license renewals.
•
Oversee and manage DEA certifications, board certifications, life support renewals, and payer enrollments for multiple insurance plans, including Aetna, BayCare, Cigna, Devoted, Florida Blue, Humana, MultiPlan, Tricare, Railroad, and United.
•
Collaborate closely with healthcare providers to ensure compliance with regulatory requirements for both government and private health plans, utilizing CAQH Proview for initial credentialing and re-credentialing.
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Conduct regular background screenings, NPDB checks, AMA Profile verifications, and clearinghouse interactions.
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Proficient in using Med Staff, SharePoint, Teams, Excel, RightFax, and various credentialing tools to streamline processes and maintain efficiency.
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Maintain up-to-date knowledge of the healthcare industry's regulatory standards, ensuring all certifications and credentials are compliant and current.
•
*******@*****.***
Winter Haven, FL 33880
EDUCATION
Bachelor of Arts, Bachelor of
Arts in Criminal Justice
National University College,
Arecibo, PR
May 2013
LANGUAGES
English
Full Professional
Spanish
Full Professional
Credentialing Certification (NAMSS)
In Progress, Expected Completion: Summer 2025
July 2021 - January 2024
Verisys Corp-Remote - Credentialing Coordinator, Louisville, KY February 2017 - July 2021
Med Advantage-Remote - Credentialing Specialist, Orlando, FL September 2015 - December 2016
International Medical Card - Junior Credentialing Specialist Led the credentialing process for new and existing healthcare providers, ensuring full compliance with state, federal, and accreditation regulations.
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Conducted thorough verifications of providers' education, training, licensure, and certifications, collaborating with both internal and external stakeholders.
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Resolved credentialing issues in a timely manner, maintaining an efficient and smooth process.
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Verified State Licenses, Board Certifications, DEA, CDS, Insurances, and Privileges for healthcare providers.
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Maintained NPI records and ensured all credentialing documents were up to date and accurate.
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Managed and updated provider data in the company's database to meet compliance standards.
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Ensured compliance with federal, state, and company regulations for multi- specialty physicians regarding licenses and certifications.
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• Maintained accurate credentialing files and updated relevant documentation. REFERENCES
Victoria Silver
Verisys Corporation /
Production Supervisor
Phone: 801-***-****
Email: ********.******@*******.***
Mark Schaerrer
Verisys Corporation /
Vice President of Human Resources
Phone : 801-***-****
Email : ****.*********@*******.***
Contact this candidate