Karissa Sanchez
Cerritos
Summary
Credentialing professional with proven track record in managing credentialing operations and ensuring compliance. Valued for strong collaborative skills and achieving results through efficient processes. Known for adaptability and reliability in dynamic environments, with expertise in documentation and regulatory standards.
Overview
10
10
years of professional experience
Work History
Credentialing Specialist
UpLift
07.2023 - 02.2025
- Initiated, maintained, and verified credentialing and re-credentialing applications
- Directed multiple priorities effectively, resulting in the on-time completion of credentialing tasks for numerous providers simultaneously.
- Created and managed CAQH accounts, ensuring timely attestations as required
- Conducted research and provided summaries for various provider types and health plan entities
- Collaborated with healthcare providers to gather necessary information for accurate credentialing decisions.
- Reduced errors in credentialing files by conducting thorough reviews and consistently maintaining attention to detail.
Senior Delegated Credentialing Coordinator
Pacific Dental Services
11.2020 - 07.2023
- Ensured dentists met NCQA Credential Verification Organization (CVO) standards and other regulatory requirements
- Communicated effectively with various parties each day using polished interpersonal and active listening skills.
- Operated the credentialing process for both initial and re-credentialing applications
- Prepared and submitted dental provider credentialing packets for committee review
- Submitted approved dental providers to insurance plans within 48 hours
- Reduced errors in documentation by thoroughly auditing provider files for completeness and accuracy.
- Managed the Insurance Provider Status Report and ensured the retrieval of relevant documentation
- Communicated process improvements and ensured compliance with company policies, as well as state, federal, and regulatory standards
Credentialing Coordinator
Network Medical Management
07.2018 - 01.2020
- Oversaw the credentialing process for all providers under LaSalle Medical Associates IPA in the LA/IE region
- Coordinated updates to the credentialing database and monitored processing turnaround times
- Elevated client satisfaction rates through prompt resolution of any provider-related issues or concerns that arose during the credentialing process.
- Worked closely with practitioners to help each obtain privileges at assigned healthcare facilities
- Prepared and coordinated credentialing audits and served as the primary contact for internal and external credentialing inquiries
- Prepared and submitted quarterly ICE reports
- Notified health plans of provider approvals and maintained positive working relationships with stakeholders
- Fostered a positive work environment through active participation in team meetings, collaborating on strategies to improve departmental performance.
Sales Associate
Nordstrom
04.2015 - 07.2018
- Certified Bra Specialist/Prosthesis
- Collaborated with health insurance agencies (e.g., Kaiser Permanente, Aetna) to facilitate customer needs
- Delivered high-quality customer service and ensured satisfaction, recommending alternative products when necessary
- Organized prosthesis paperwork, sales floor, and cash register operations
Education
Cerritos College - Communications
Cerritos College
Norwalk, CAHigh School Diploma -
Cerritos High School
Cerritos, CASkills
- HIPAA compliance
- Background checks
- NCQA Standards Compliance
- Provider enrollment
- Data management
- Microsoft Suites
- Google Workplace
- License verifications
- Task Prioritization & Time Management
- Training and mentoring
- Detail-Oriented & Highly Organized
- Medical, Dental, and Therapy Services Credentialing
Timeline
Credentialing Specialist
UpLift
07.2023 - 02.2025
Senior Delegated Credentialing Coordinator
Pacific Dental Services
11.2020 - 07.2023
Credentialing Coordinator
Network Medical Management
07.2018 - 01.2020
Sales Associate
Nordstrom
04.2015 - 07.2018
Cerritos College - Communications
Cerritos College
High School Diploma -
Cerritos High School
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