Experienced Medical and Behavioral Health Credentialing Specialist with over 2 years of professional experience supporting U.S.-based healthcare organizations and administrative operations. Specialized in provider enrollment, insurance credentialing, payer relations, medical billing support, prior authorizations, and patient coordination. Proven track record of successfully credentialing healthcare providers across multiple insurance networks, managing CAQH profiles, navigating payer portals, resolving enrollment issues, and ensuring compliance with regulatory and payer requirements.
Most recently, I served as a Medical and Behavioral Health Credentialing Specialist for Mochi Health and Neupathway Psychiatric Services, where I managed end-to-end credentialing and enrollment processes for physicians and behavioral health providers. My experience includes working directly with major insurance payers, maintaining provider records, verifying benefits, posting ERAs and EOBs, processing prior authorizations, supporting billing operations, and coordinating patient services.
Recognized for strong attention to detail, excellent communication skills, and the ability to independently manage multiple credentialing projects while collaborating with providers, insurance representatives, pharmacies, and healthcare teams. Adept at handling sensitive healthcare information, maintaining compliance standards, and improving operational efficiency in fast-paced remote environments.
**HIGHLIGHTS OF QUALIFICATIONS**
* End-to-end Provider Enrollment and Insurance Credentialing
* Behavioral Health Provider Credentialing and Re-Credentialing
* CAQH Profile Management and Attestation
* Payer Portal Navigation and Application Submission
* Insurance Verification and Benefits Investigation
* Prior Authorization Processing and Follow-Up
* Medical Billing Support, ERA and EOB Posting
* Claims Submission Assistance and Resolution
* Provider Express (Optum), UHC, Availity, OneHealthPort, Evernorth (Cigna)
* Patient Coordination and Appointment Scheduling
* Pharmacy Coordination and Compounding Support
* Compliance Monitoring and Documentation Review
* Provider, Patient, and Insurance Company Communication
* Staff Training and Workflow Support
**RECENT HEALTHCARE EXPERIENCE**
**Behavioral Health Credentialing Specialist, Billing Agent & Phone Receptionist**
*Neupathway Psychiatric Services | April 2025 – June 2026*
* Managed credentialing and re-credentialing processes for behavioral health providers across multiple insurance networks.
* Submitted, tracked, and followed up on provider enrollment applications to ensure timely network participation.
* Maintained and updated CAQH profiles and provider records.
* Utilized Availity, Provider Express (Optum), UHC Provider Portal, OneHealthPort, and Evernorth (Cigna) for credentialing, eligibility verification, benefits investigation, and enrollment management.
* Independently communicated with insurance payers to resolve credentialing delays, application discrepancies, and enrollment issues.
* Posted ERAs and EOBs accurately to support billing operations and revenue cycle processes.
* Coordinated patient scheduling, handled inbound calls, and provided administrative support using PracticeQ and Google Voice.
* Assisted with onboarding and training tea-----------mbers on credentialing workflows and payer portal processes.
* Ensured compliance with payer requirements, provider documentation standards, and credentialing regulations.
**Medical Credentialing Specialist, Billing Support & Compounding Agent**
*Mochi Health | June 2024 – March 2025*
* Managed provider enrollment and credentialing for physicians seeking participation with multiple U.S. insurance payers.
* Maintained CAQH profiles and submitted credentialing applications through payer portals.
* Tracked application statuses and communicated directly with insurance companies to expedite approvals.
* Assisted providers with claims-related concerns and billing support activities.
* Processed prior authorization requests for weight-loss medications and treatments.
* Coordinated compounded medication orders, including semaglutide and tirzepatide prescriptions, with partner pharmacies.
* Addressed patient concerns, resolved complaints, and provided ongoing support throughout the treatment process.
* Processed subscription cancellations and initiated refund investigations when appropriate.
* Collaborated with providers, pharmacies, insurance representatives, and internal teams to ensure seamless patient care and operational efficiency.
