Kim Navedo Email & Phone Number

Fredericksburg, Va, Us

Manage licensure, payor enrollment, and credentialing for clinicians (MD, NP, PA, RN, LCSW, PharmD), work closely with Clinical Care Services, Market Clinical Operations, People Ops, and Compliance teams to manage a best-in-class credentialing function.• Fully manage and run licensing and credentialing program and optimize where opportunities exist.• Provide introductions to new providers and work closely with them to support the credentialing and licensing application process.•… Show more Manage licensure, payor enrollment, and credentialing for clinicians (MD, NP, PA, RN, LCSW, PharmD), work closely with Clinical Care Services, Market Clinical Operations, People Ops, and Compliance teams to manage a best-in-class credentialing function.• Fully manage and run licensing and credentialing program and optimize where opportunities exist.• Provide introductions to new providers and work closely with them to support the credentialing and licensing application process.• Maintain record of current state licensure, DEA certification, malpractice coverage, and other required credentialing/licensing documentation and expiration dates for all providers.• Project manage renewal process for all provider licensing and credentialing.• Work with new providers to establish licensure and work through the credentialing process with health plan partners.• Serve as a point person to health plan partners to process, update, and manage credentialing submission and recredentialing needs.• Lead efforts around building in-house credentialing and licensing functions, as applicable. Show less

Responsible for all aspects of licensing talk therapy and telehealth providers across multiple states. Completes and submits license applications and follows the process closely to ensure timely approval. ▪ Develop credentialing processes and procedures, overseeing day-to-day implementation.▪ Monitors process, and document all provider licenses and renewals, as well as credentialing for all state Medicaid and health plans accurately and in a timely manner prior to… Show more Responsible for all aspects of licensing talk therapy and telehealth providers across multiple states. Completes and submits license applications and follows the process closely to ensure timely approval. ▪ Develop credentialing processes and procedures, overseeing day-to-day implementation.▪ Monitors process, and document all provider licenses and renewals, as well as credentialing for all state Medicaid and health plans accurately and in a timely manner prior to expiration.▪ Monitor credentialing & licensing statuses for all licensed clinical providers, tracking re-credentialing requirements and creating new workflows as needed.▪ Oversees provider and staff license applications and credentialing forms and gathers required supporting documents, fees, and signatures within required timeline for state board approval.▪ Research and document required licenses and credentialing for company. Show less

United States

Identify and resolve emerging issues by processing initial provider applications and documents. Follow up with healthcare providers when required to gather missing information. Complete and proceed payer enrollment applications to facilitate healthcare providers in Medicare, commercial managed, and other market-identified plans. Manage and update provider profiles in CAQH, PECOS, NPPES, and credentialing software in an accurate manner. Build close and impactful relationships with payors and… Show more Identify and resolve emerging issues by processing initial provider applications and documents. Follow up with healthcare providers when required to gather missing information. Complete and proceed payer enrollment applications to facilitate healthcare providers in Medicare, commercial managed, and other market-identified plans. Manage and update provider profiles in CAQH, PECOS, NPPES, and credentialing software in an accurate manner. Build close and impactful relationships with payors and retain confidentiality of provider data. Deliver updated demographic information along with supporting documents to external stakeholders, including commercial managed care plans and contracted billing entities. ▪ Successfully delivered re-credentialing within defined timelines to bridge enrollment gaps.▪ Eliminated enrollment with commercial and government payers, based on resignation/termination of providers. ▪ Determined authenticity of information through primary source verification; created files for committee evaluation.▪ Served as liaison between organization and payers; completed and submitted on-time ERA, EDI, and EFT paperwork. ▪ Assessed and updated documents about to expire, such as license, DEA, board certifications, and malpractice to ascertain seamless execution of all processes. Show less

Aberdeen, North Carolina, United States

Created medical charts immediately after cataract, cosmetic, glaucoma, and emergency surgery procedures with focus on supporting timely coding and billing while working efficiently in clinical area of the surgery center in the PACU. Ascertained accuracy of all records by organizing and reviewing financial information, anesthesia consent, billing insurance, surgery charge tickets, physicians’ chart notes, and operation records.▪ Entered correct surgery information and details into HST… Show more Created medical charts immediately after cataract, cosmetic, glaucoma, and emergency surgery procedures with focus on supporting timely coding and billing while working efficiently in clinical area of the surgery center in the PACU. Ascertained accuracy of all records by organizing and reviewing financial information, anesthesia consent, billing insurance, surgery charge tickets, physicians’ chart notes, and operation records.▪ Entered correct surgery information and details into HST computer program for each patient, per visit; ensured documentation of updated medical procedures and information.▪ Executed audit of medical charts after scanning into database via Scancharts software, focused on providing accessibility of all procedures and required paperwork to associates. Show less

Lorton, Va

Managed accounting-related data entry and reports in Team Management System (TMS) to assist Human Resource Manager in a remote setting. Enabled timely payroll preparation and processing as well as job cost assessment; generated accounting reports. Leveraged keen attention to detail; reserved updated accounting records.▪ Aligned with defined regulations while researching and allocating call slips for jobs and work completed at 12 government facilities, including West Point, Department of… Show more Managed accounting-related data entry and reports in Team Management System (TMS) to assist Human Resource Manager in a remote setting. Enabled timely payroll preparation and processing as well as job cost assessment; generated accounting reports. Leveraged keen attention to detail; reserved updated accounting records.▪ Aligned with defined regulations while researching and allocating call slips for jobs and work completed at 12 government facilities, including West Point, Department of Labor, and TSA and William Clinton Building in NY and Washington D.C.▪ Elevated staff skills in timesheet management as well as ADP and TMS timekeeping software by training more than 12 facilities with over 100 employees. Show less