Customer Service Project Management

PROFESSIONAL SUMMARY

Accomplished healthcare operations professional with expertise in managing daily practice functions, regulatory compliance, and provider enrollment. Recognized for driving productivity, maintaining quality standards, and enhancing customer satisfaction. Skilled in policy development, operational improvements, audits, and confidential data management. Strong collaborator and problem solver with experience in resource allocation, payment resolution, and stakeholder engagement. Adept at leading teams, fostering positive work environments, and ensuring excellence in service delivery and compliance.

SKILLS

Fluent in Spanish

Project Management

Hiring & Onboarding

Data Analysis

Strong writing and reading aptitude

Budget Management

Ability to handle confidential materials and matters

Excellent communication skills

Ability to handle multiple tasks and projects simultaneously

Strong organizational and follow-up skills Event planning

Proficient with Microsoft Word, Excel, PowerPoint, Outlook, Adobe, Medical Manager, ECHO and EPIC

Personalized Customer Service

PROFESSIONAL EXPERIENCE

CHILDREN’S HOSPITAL OF PHILADELPHIA — PHILADELPHIA, PA

Physician Practice Manager, 7/2021 to 5/2023

Proficiently manage day-to-day medical practice operations.

Ensure strict adherence to industry regulations and standards.

Prepare compelling presentations, letters, and reports.

Perform advanced administrative tasks, including call triage and coordination.

Collaborate effectively for new employee onboarding and equipment requirements.

Handle confidential information for a large 150-provider group.

Respond adeptly to complex inquiries and assist stakeholders.

Maintain efficient record-keeping systems and procedures.

Interact seamlessly with physicians, addressing their concerns.

Skillfully coordinate meetings, interviews, and events.

Organize regular staff meetings and conduct performance reviews.

Foster teamwork to achieve practice objectives.

Monitor and manage inventory and supplies efficiently.

CHILDREN’S HOSPITAL OF PHILADELPHIA — PHILADELPHIA, PA

Lead Credentialing and Privileging Coordinator, 5/2018 to 7/2021

Conducted weekly audits of confidential and privileged documents and databases.

Provided detailed reports to division administrators, ensuring document and file status transparency.

Efficiently supported medical staff teams and committees, managing collection and distribution cycles.

Skillfully coordinated initial and recredentialing processes, verifying licenses, certifications, and competency.

Created expedited reports to streamline credentialing file processing.

Demonstrated excellent leadership by overseeing workflows, training team members, and assigning tasks.

Managed confidential access codes and ensured prompt verification of provider credentials.

Handled appointment notifications and medical staff invoices with precision.

Maintained and updated a comprehensive credentialing database.

Proficiently handled data requests and organized document storage and retrieval.

Demonstrated expert knowledge of accreditation standards and facilitated successful audits.

Committed to delivering exceptional customer service, resolving queries within 24 hours.

Utilized strong problem-solving skills and exercised independent judgment.

Efficiently coordinated team projects and meticulously maintained project documentation.

Displayed expertise in credentialing standards and regulations, ensuring compliance and accuracy.

CHILDREN’S HOSPITAL OF PHILADELPHIA — PHILADELPHIA, PA

Enrollment Manager, 2/2008 to 5/2018

Managed a 6-member Enrollment team for a 30 multi-specialty practice group with 1100 providers, ensuring high service levels and goal attainment.

Oversaw productivity and quality of enrollment and credentialing activities to meet rigorous standards.

Fostered a collaborative and inspiring team environment, serving as a positive role model for the department.

Developed and maintained comprehensive credentialing and enrollment manuals, along with departmental policy and procedure guidelines.

Implemented operational improvements to achieve objectives, address customer needs, and optimize resource allocation.

Skillfully managed confidential information in EPIC & ECHO systems and efficiently resolved payment issues related to provider enrollment.

Nurtured strong relationships with internal and external stakeholders, adhering to company policies and best practices.

Collaborated with management to strategize resource allocation and resolve significant matters pertaining to provider enrollment and payment concerns.

Spearheaded core business procedures and process improvement initiatives, elevating customer service and fulfilling contractual commitments.

Acted as the organization's representative in credentialing meetings with external entities, proactively addressing lags and trends through audits and report monitoring.

Conducted employee selection, training, and evaluations, contributing to enhanced performance and professional growth.

Addressed performance concerns and provided personnel recommendations when necessary.

CHILDREN’S HOSPITAL OF PHILADELPHIA — PHILADELPHIA, PA

Lead Enrollment Specialist, 3/2007 to 1/2008

Accurately maintained 500+ confidential provider files

Serve as a liaison between 30+ practice locations & 100 various insurance plans

Manage the enrollment & continued participation of all providers with the various insurance plans

Developed forms & protocols to monitor all Managed Care policies and procedures

Quickly and effectively solved customer challenges

GREATER PHILADELPHIA HEALTH ACTION – PHILADELPHIA, PA

Managed Care Coordinator, 8/2002 to 3/2007

Oversaw all Managed Care and Enrollment activities for 10-site practice

Served as a liaison between 10 practice locations & 25 insurance plans

Accurately maintained 70+ provider files

Managed the enrollment & continued participation of all providers with the various insurance plans

Developed forms & protocols to monitor all Managed Care policies and procedures

Trained new and existing employees on the Managed Care Processes

Quickly and effectively solved customer issues

GREATER PHILADELPHIA HEALTH ACTION – PHILADELPHIA, PA

Billing Specialist, 5/2001 to 8/2002

Skillfully handled billing processes for an 8-site medical practice.

Processed all encounter forms promptly and efficiently.

Gathered any missing information required for accurate billing submissions.

Demonstrated an in-depth understanding of billing policies and procedures for 15 insurance plans.

Generated and managed reports and spreadsheets for various purposes.

APPAREL MACHINERY – PHILADELPHIA, PA

Administrative Assistant/Order Entry Clerk, 6/1999 to 4/2001

Demonstrated proficiency in multitasking and successfully completing multiple tasks in a fast-paced environment.

Efficiently managed and handled incoming calls.

Compiled and organized expense logs systematically.

Provided timely service and support to Spanish-speaking clients.

Maintained and managed inventory to ensure an appropriate stock level.

ELITE ADVANTAGE, INC. – PHILADELPHIA, PA

Senior Billing Specialist, 6/1996 to 12/1998

Managed billing operations for multiple corporations, demonstrating skill and expertise.

Provided excellent customer service and support to clients.

Took on the role of training and supervising new employees.

Effectively handled inquiries from Spanish-speaking clients.

Ensured accuracy in billing by acquiring any missing information.

Maintained a comprehensive understanding of billing policies and procedures for 10 insurance plans.

CITY OF PHILADELPHIA – PHILADELPHIA, PA

Bilingual Police Communication Dispatcher, 6/1994 to 6/1996

Identify and report emergency situations promptly.

Remain calm and communicate effectively with victims while coordinating emergency response efforts.

Accurately document and enter detailed information related to the emergencies.

Handle calls from Spanish-speaking victims promptly and effectively.

Dispatch assignments to the appropriate personnel and prioritize the safety of police officers.

EDUCATION

DIPLOMA AWARDED, 6/1988 - BUSINESS ADMINISTRATION

Mastbaum Vocational Technical school — Philadelphia, PA

VOLUNTEER

TREASURER – 5/2013 - PRESENT

Ferko Playground — Philadelphia, PA

REFERENCES

AVAILABLE UPON REQUEST

Contact this candidate