US healthcare credentialing, provider enrollment, medical billing, and revenue-cycle professional with 7+ years of combined provider, payer, billing, customer-service, and remote administrative experience.
More than four years supporting Endocrine and Psychiatry Center (EPC), a multi-specialty Texas practice with approximately 15 providers across two locations. Experience includes payer enrollment and follow-up, CAQH profile maintenance, NPPES/NPI data, individual and group enrollment workflows, W-9s and provider rosters, contracting, network verification, effective dates, provider loading, EFT/ERA, claims and denial follow-up, eligibility and benefits, prior authorizations, referrals, chart creation, scheduling, and HIPAA-aware documentation.
Payers and systems: UHC/Optum, BCBS, Aetna, Cigna/Evernorth, Community Health Choice, Ambetter/Superior, Oscar and other US payers; athenaOne, Availity,
Claim.MD, payer portals, Google Sheets, Google Workspace, and Microsoft Office.
Specialty experience: endocrinology, dietitian/medical-nutrition services, psychiatry, and mental health. Comfortable calling US insurers and practices, resolving enrollment or billing discrepancies, documenting reference numbers, and managing high-volume follow-up.
AI competency: ChatGPT, Claude, and Gemini for non-PHI payer research, SOP drafting, spreadsheet support, workflow analysis, and process improvement, with human verification and privacy safeguards.
