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Credentialing Coordinator with more than seven years of valuable, hands-on healthcare experience.
Strong knowledge of managed care operations, including working with dentists and office managers.
Collaborated with other departments to determine IPA provider specialty needs.
Stellar knowledge of credentialing standards and requirements for the National Committee for Quality Assurance (NCQA); National Practitioner Data Bank (NPDB); NPI (National Provider Identification); OIG (Office of Inspector General); U.S. Drug Enforcement Agency (DEA); Cardiopulmonary Resuscitation (CPR); and DBOC (Dental Board of California), among others.
Familiar with re-hire eligibility, recruiting verification, attestation statements and malpractice coverage and professional liability.
Proficient with Microsoft Office Suite and Access; Cactus; FlexCare Credit; Raintree; QuickBooks; Peachtree; Lotus Notes; AS/400; ADP Virtual Edge; and Automated Tracking Systems (ATS).
Fluent in English and Tagalog.
Developed and maintained standard processes for credentialing data, ensuring database integrity and compliance with legislative, regulatory and accrediting body requirements.
Received and processed necessary forms and reports related to credentialing.
Verified licenses according to WDS rules and regulations pertaining to the credentialing process.
Performed Primary Source Verification for credentialing and confirmed facility accreditation and licenses.
Communicated effectively with other departments regarding the credentialing process, including billing, quality management, human resources, professional staff and dentists.
Telephoned providers to proactively communicate critical expiration dates and monitor status.
Followed up with personnel in the network contracting and provider relations departments when provider applications were incomplete.
Participated on the Credentialing Committee, including coordinating record minutes and preparing files, and also served on a Peer Review Committee.
Office Assistant, Name of Social Services Agency Santa Ana, CA Mar. 2015-Present
Credentialing Data Specialist, Beacon Health Strategies Cypress, CA Apr. 2014-Dec. 2014
Self-Employed Anaheim, CA Apr. 2012-Mar. 2014
Credentialing Coordinator (promoted in Jan. 2006), Western Dental Orange, CA Sept. 2005-Apr. 2011
Accounting Clerk, Advanced Tax and Financial Advisors, Inc. Fountain Valley, CA Apr. 2004-July 2005
Bachelor of Science (BS), Business Accounting and Business Management (double major); earned 2007
Southern California Institute of Technology
Associate of Arts (AA), Accounting; earned 2003
Coastline Community College
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