Jan Paoleen Rafallo

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CREDENTIALING TEAM LEADER

CF Staffing Solutions Inc.

Apr 2024 - Current (2 years 5 months)

All the mentioned Job Roles below (Microsourcing ; WC Health) Lead, mentor, and supervise a team of credentialing specialists Oversee the team's performance, address internal risks & conducts coaching Cross-functional in RCM workflows especially in Claim Denials Training and Development Continuous improvement of KPIs

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CREDENTIALING SPECIALIST

WC Health

Jun 2023 - Mar 2025 (1 year 10 months)

Provider Enrollment, end to end process of credentialing and recredentialing to insurance/payors, ensuring compliance with states health accreditation agencies (e.g CMS, TJC) Proactively communicates with providers to obtain and verify credentials Maintains collaborative relationships with insurance companies,, hospital staff, office personnel, clinic managers, board of directors, other Internal staff and state government regulatory agencies. Medicaid/Medicare (PECOS) initial application, revalidations and maintenance Manage provider directories supplied by the insurance companies (e.g. Availity, Optum Express) Hospital Privileging for Providers (e.g. MD-Staff, VHS, St. Rose, RBH, Encompass) Payor Rosters with all the Managed Care Organizat

CREDENTIALING ADVISOR

Epic Staffing Group

Mar 2022 - Jun 2023 (1 year 4 months)

Audit clinician's files & ensure credentialing compliance to TJC regulations Communicate with Clinicians via Emails, Calls & Texts Integration with Clients, Account Managers, Recruiters and other Internal & External relations Run monthly background checks / sanctions (OIG, SAM, OFAC) Set up and schedule clinicians through vendor systems for their medical tests Manage vendor sites regarding scheduled medical and competency exams of clinicians Validate and Verify documentations and credentials of providers

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SERVICE SCHOLAR

MMP

Jan 2017 - Jan 2019 (2 years 1 month)

Accomplished Liquidations and Invoices in Accounting Dept. Admin tasks and Assembly/Event organizing Interviewed applicants; Children, Aging and Families Accomplished the minutes every meeting/assemblies Support social workers to assist sponsored children, aging and families Travel to duty to the areas of sponsored people to mentor, counsel and be a speaker for talks Assist sponsored people to connect with their Sponsors across worldwide through Paper writing

Jan Paoleen Rafallo

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