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Experienced Credentialing Specialist adept at conducting application reviews and primary source verifications. Excellent relationship-building, problem-solving and communication skills. Seeking to be part of a company that gives the opportunity to grow and earn CPCS certification.
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- Possess knowledge and understanding of the reappointment process.
- Obtains current certificate of insurances, medical licenses, DEA certificates, life support certificates, and other required expirable documents from Healthcare Providers.
- Possess excellent interpersonal and communication skills and the ability to work independently as well as part of a team.
- Processes and review Reappointment Applications for Physicians and Allied Health Practitioners following the Medical Staff Bylaws, Rules and Regulations, and the policies and procedures for Credentialing.
- Maintain confidentiality of Providers Data
- Maintain the Practitioners database by updating or imputing new information regarding Jobs, Education, Licenses, Training, etc.
- Process and properly document resignations, temp inactivation due to expirable documents, leave of absences, etc.
- Communicates effectively with Practitioner regarding any expirable document, or any missing information during reappointment process.
- Performs Primary Source Verification(PSV ) for medical licenses, boards, hospital Affiliations, national practitioner data bank ( NPDB) queries, Federation of State Medical Board ( FSMB ), Florida office of insurance regulation ( DOI ) , DEA diversion control
- Answer general inquiry questions related to program requirements, application processing, case status and benefits information.
- Educate customers on community partners and the benefits/features of my Access Account.
- Assist customers with referrals to other agencies and community resources.
- Conducts abbreviated interviews for the purpose of collecting and updating required information on applicants and recipients and their household members for all public assistance programs.
- Requests all additional information/verification required to establish or continue eligibility for public assistance programs according to Department procedures.
- Ensure electronic case records are documented thoroughly and properly as required by department procedures.
- Takes appropriate corrective action on identified error through the quality management system, management evaluation reviews, and quality control reviews.
- Maintain and develops professional knowledge and skills by participating in supervisory performance conferences, staff meeting, mandatory training and workshops as assigned or required.
- Performs special work assignments and other related work duties as required or assigned.
- Highly experience in assessing customers' needs and advising coverage options.
- Hands on experience in developing and maintaining relationships with customers.
- In depth knowledge of standard insurance products, pricing, and policy features.
- Assessed needs and provide coverage options.
- Calculated premiums amount and set payment methods and options.
- Determined if prospect qualifies for financial assistance based on Household Size and Projected Income.
- Educated prospect in different ways to apply.
- Handled inbound service calls from customers.
- Assisted customer to set up claims related to fraud or disputes covered under regulation.
- Answered questions regarding new &existing fraud & dispute claims within standards.
- Resolved problems & complaints that customers may have about Regulations.
- Setting up check fraud, identity theft & wire fraud cases & handle fraud detection calls.
- Ability to make decisions using knowledge of policies procedures & regulations.
- Conducted research on moderately complex customer issues.
- Received & resolved most complex calls customer issues & interpret policy & procedure.
- Educated customer and offer tools to help them avoid fraud and identity theft.
- Reported any unusual activity on accounts in order to protect the bank ( Fraud Saves).
Pontificia Universidad Javeriana - Cali, Colombia,
- BUSINESS ADMINISTRATION, PONTIFICIA UNIVERSIDAD JAVERIANA,
CERTIFICATIONS AT LYNDA.COM
• Being an effective Team Member 12/2020
• Customer Service: Serving Internal Customers 12/2020
• Conflict Resolution Foundations 10/2019
• Social Media Marketing Tips 08/2019
• Managing Brand reputation 08/2019
• Cybersecurity Awareness: Social Network at Work 08/2019
• Building Online Communities 08/2019
• Phone-Based Customer Service 08/2019
• Customer Service: Creating Customer Value 08/2019
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School Attended
- Pontificia Universidad Javeriana
Job Titles Held:
- Credentialing Specialist
- Interviewing Clerk
- Health Insurance Agent
- Fraud Analyst
Degrees
- BBA
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