Diana DeVera
Pittsburgh
Summary
Licensing and Credentialing professional with solid expertise in managing and verifying credentials for healthcare providers. Strong focus on team collaboration and achieving results. Reliable and adaptable, meeting organizational standards and compliance requirements. Skilled in data management, regulatory compliance, and communication.
Overview
11
11
years of professional experience
Work History
Licensing and Credentialing Specialist
Rayus/Foundation Radiology Group
Wexford, PA
03.2020 - Current
- Quality control measures: Ensuring standards and practices are conducted above board.
- Provider liaison for radiologists regarding credentialing information.
- Departmental Liaison for various insurance brokers for coverage and insurance needs
- Obtain Medical licenses and renewal for providers for many states across the country.
- Ensured license and forms were current and up to date.
- Verification of education i.e., Medical School, Residencies, Internships and Fellowships
- Assisted provider with application formations and direct contact with various Medical Staff Offices
- Verify education and certifications are legitimate via AMA and investigate though various nation and state wide sources.
- Managed credentialing processes for healthcare professionals, ensuring compliance with regulatory standards.
- Streamlined provider enrollment procedures, enhancing efficiency and reducing turnaround times.
- Led initiatives to improve data accuracy within credentialing databases and systems.
- Developed training materials for new staff on credentialing policies and procedures.
- Analyzed credentialing workflows, identifying areas for process optimization and improvement.
- Mentored junior team members, fostering professional development and adherence to best practices.
Credentialing Coordinator
UPMC
Pittsburgh, PA
05.2018 - 08.2019
- Worked with various departments (CVO, MSO and department administrators) to coordinate a comprehensive report for Health Information Services
- Held and attending meetings with various departments to update, inform and obtain information regarding hiring status, credentials needed and practice location allocation.
- Assist Providers with questions regarding credentialing information
- Performed the above listed tasks for 5 different departments under one division for the Department Of Medicine (Hematology/ Oncology, Gastroenterology, Pulmonary, Palliative Care and General Medicine)
- Ensured license and forms were current and update
- Coordinated credentialing processes for healthcare providers, ensuring compliance with regulatory standards.
- Streamlined provider data management systems, enhancing accuracy and efficiency of credentialing workflows.
- Reviewed and verified documentation for licensure and certifications, maintaining high standards of quality control.
Credentialing/Provider Operations
Gateway Health
Pittsburgh
06.2015 - 03.2018
- Assist Providers with questions regarding credentialing information.
- Investigate, verify, and submit current licenses and education to the company.
- Maintain file formats to ensure online information accuracy.
- Data entry
- Assist Providers with questions regarding claim information.
- Provide actuate call log information to improve Provider Relations
- Call back Providers unable to speak with a live representative after normal business hours.
- Junior training for new representatives
Education
Bachelor of Science - Business Ethics
Art Institute of Pittsburgh
Pittsburgh, PA03-2005
Skills
- HIPAA compliance
- Background checks
- License verifications
- Data management
- Provider relations
- Credential verification
- Application coordination
- Report generation
- Adobe Products expertise
- Facility credentialing
- Database maintenance
- Employee onboarding
Timeline
Licensing and Credentialing Specialist
Rayus/Foundation Radiology Group
03.2020 - Current
Credentialing Coordinator
UPMC
05.2018 - 08.2019
Credentialing/Provider Operations
Gateway Health
06.2015 - 03.2018
Bachelor of Science - Business Ethics
Art Institute of Pittsburgh