Billing & Credentialing Specialist with 10+ Years Experience
Resume:
Contact Information
Name: Theresa Padilla
Phone: 702-***-****
Email: *************@*****.***
LinkedIn: www.linkedin.com/in/theresa-padilla-b70508b8
Professional Summary
I am a dedicated Billing & Credentialing Specialist with over 10 years of experience in healthcare billing, insurance administration, and staff credentialing. I excel in streamlining revenue cycles, ensuring regulatory compliance, and supporting providers with accurate and efficient processes. Currently pursuing NAMSS CPCS certification, I am eager to bring my expertise and commitment to accuracy to a forward-thinking healthcare organization.
Skills
Technical Skills
Knowledge of Dental and Medical Terminology
QuickBooks and Accounts Payable
Administrative Skills
Credentialing of Providers
Tracking and Monitoring (INS, NPBD, OIG, Nevada State Dental Examiners)
Compliance with Business and Operating Licenses
Tracking Employees' Time, PTO, and Sick Time
Overseeing Pre-Employment Drug Testing and Documentation
Ensuring Employees Health Cards and Other Required Documentation
Organizational Skills
Strong Organizational Skills
Capable of Working Effectively Independently
Able to Work in a Demanding Environment Handling Multiple Demands
Management Skills
People’s Skills
Excellent Verbal and Written Communication Skills
Maintaining Confidentiality Standards
Providing Exceptional Customer Service
Professional Experience
Ageless Men’s Health
Billing Specialist (08/2024 – current)
10501 W Gowan Road Suite 200 Las Vegas, NV
Processed payments and precisely updated customer accounts.
Reconciled billing statements and resolved discrepancies.
Oversaw customer inquiries on billing issues, ensuring excellent service.
Filed and followed up on insurance claims to secure payments.
Maintained detailed records of transactions and communications.
Enforced billing regulations and company policies, managed medical records, and conducted insurance verifications as needed.
Ear, Nose, and Throat Surgery Center
Billing and Credentialing Supervisor (04/2019 – 07/2024)
8840 W Sunset Road Suite B, Las Vegas. NV
Managed all aspects of patient billing and collections, including taking calls and payments, sending out statements and balances, and working with the Finance Manager on patient refunds.
Managed daily transactions from banking institutions, inputting daily charges, and managing accounts receivable.
Communicated with collections and managed correspondence emails for claims management.
Ran weekly reports for any unposted charges and posted payments.
Supervised business licensing, compliance, and medical staff credentialing with the oversight of clinical management and the Practice Administrator.
Maintained a professional demeanor and appearance while ensuring the confidentiality of patients, physicians, and coworkers.
Efficiently provided exceptional customer service online, over the phone, or in person.
Canyon Oral and Facial Surgery
Treatment Plan Coordinator (03/2016 – 07/2018)
6200 N Durango Drive Suite 100, Las Vegas, NV
Regularly interacted with oral surgeons to provide payment plans for patients.
Addressed phone calls and emails from patients regarding treatment questions.
Submitted preauthorization requests to insurance companies.
Verified insurance coverage for patients.
Processed daily office deposits.
Checked out patients after their appointments and greeted and checked in patients upon arrival.
Liberty Dental Plan
Member Services Representative (02/2010 – 03/2016)
6385 S Rainbow Blvd Unit 200, Las Vegas, NV 89118
Answered inquiries related to dental benefits, eligibility, provider information, claims, grievance, and appeals.
Fulfilled requests and managed miscellaneous inquiries.
Observed all local, state, and federal guidelines and regulations.
Certifications
NAMSS, Las Vegas, NV
Currently undergoing the CPCS certification process.
College of Southern Nevada, Las Vegas, NV
Associate of Arts Degree (in progress), GPA: 3.1.
References
Available upon request.
Contact this candidate