Helen Vela, CPCS
Credentialing Specialist at HealthTexas Medical Group- Claim this Profile
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Bio
Credentials
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NAMSS Certified Provider Credentialing Specialist (CPCS)
NAMSS - National Association Medical Staff ServicesOct, 2021- Nov, 2024
Experience
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HealthTexas Primary Care Doctors
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United States
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Medical Practices
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1 - 100 Employee
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Credentialing Specialist
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Nov 2015 - Present
Process applications for appointments, reappointments, licensures, certifications, and other credentialing associated with insurance carrier contracting and/or delegation agreement(s) ensuring NCQA standards are being maintained. Scored 100% on United Healthcare delegated audits from 2019-present. Monitor monthly sanction reports such as OIG, SAM, and the Texas Medical Board. Add and make demographic changes in EcW and Ezcap databases for referral and claims purposes Process applications for appointments, reappointments, licensures, certifications, and other credentialing associated with insurance carrier contracting and/or delegation agreement(s) ensuring NCQA standards are being maintained. Scored 100% on United Healthcare delegated audits from 2019-present. Monitor monthly sanction reports such as OIG, SAM, and the Texas Medical Board. Add and make demographic changes in EcW and Ezcap databases for referral and claims purposes
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University Health
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United States
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Hospitals and Health Care
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700 & Above Employee
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Medical/ Dental Staff Coordinator
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Jun 2013 - Nov 2015
Organized and maintained the credentialing/privileging of applicants for initial appointment, provisional, and re-appointment in compliance with the defined schedules and meeting the Joint Commission standards. Provided such information to the Credentials Committee to determine the competency of practitioners to provide patient care, medical/clinical knowledge, practice-based learning, and improvement, interpersonal and communication skills, professionalism, and system-based practice. Investigated issues of concern, generated reports, and presented findings to management. Processed requests for temporary privileges and observational status to ensure compliance with established policy and procedures. Collaborated with management to recommend changes in best practices for credentialing and privileging of medical-dental staff ensuring cost effective means in the process of verification of credentials. Assisted with medical-dental staff standing, ad-hoc and special committee meetings. Demonstrated excellent communication skills in preparation of agenda, participation in meetings, and follow-up actions. Maintained and monitored the committee minutes, meeting attendance and provided follow-up.
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WellMed Medical Management
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United States
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Hospitals and Health Care
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700 & Above Employee
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Credentialing Specialist
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Nov 2010 - Jun 2013
Job duties include preparing and maintaining reports of credentialing activities such as accreditation, membership or facility privileges. Ensure that all information meets federal and state guidelines when processing applications. Credential and re-credential both employed providers as well as commercial providers in various states. Request admitting privileges at a hospital, process the application to make sure the doctor is eligible; maintain all the records and documentation of the application and verification. Keep a facility's accreditation up to date and assist auditors.
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InGenesis, Inc.
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United States
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Staffing and Recruiting
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200 - 300 Employee
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Credentialing Specialist
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Aug 2009 - Nov 2010
Credentialed various healthcare providers for employment aboard military installations in San Antonio. Verified employment, licensure, and education using primary source verification. Assisted in the process for becoming paperless by scanning all provider files and labeling all documents in company's system. Credentialed various healthcare providers for employment aboard military installations in San Antonio. Verified employment, licensure, and education using primary source verification. Assisted in the process for becoming paperless by scanning all provider files and labeling all documents in company's system.
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Centene Corporation
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United States
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Hospitals and Health Care
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700 & Above Employee
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Credentialing Specialist
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Aug 2008 - Aug 2009
Credentialed and re-credentialed healthcare providers for the South Carolina Medicaid program Maintained monthly monitoring reports for licensure and disciplinary actions. Assigned work to fellow team members as well as entered new provider applications into Cactus system. Credentialed and re-credentialed healthcare providers for the South Carolina Medicaid program Maintained monthly monitoring reports for licensure and disciplinary actions. Assigned work to fellow team members as well as entered new provider applications into Cactus system.
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ValueOptions, Inc.®
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United States
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Health, Wellness & Fitness
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500 - 600 Employee
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Credentialing Specialist
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Jul 2006 - Aug 2008
Prepared and maintained reports of credentialing activities such as accreditation, membership or facility privileges. Ensured that all information met federal and state guidelines when processing applications. Credentialed and re-credentialed various mental health providers throughout the United States. Prepared and maintained reports of credentialing activities such as accreditation, membership or facility privileges. Ensured that all information met federal and state guidelines when processing applications. Credentialed and re-credentialed various mental health providers throughout the United States.
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US Navy
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United States
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Armed Forces
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700 & Above Employee
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Hospital Corpsman
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Mar 2003 - Jun 2006
-Maintained and processed beneficiary consults, authorizations, and results in the Referral Management 15,000+ member database -Generated weekly reports for the board of directors minimizing and monitoring the costs of medical care for the Department of Defense beneficiaries -Procured office supplies and equipment for six departments maximizing a $30,000budget. -Administered the department safety training on a monthly basis ensuring regulation compliance. -Maintained and processed beneficiary consults, authorizations, and results in the Referral Management 15,000+ member database -Generated weekly reports for the board of directors minimizing and monitoring the costs of medical care for the Department of Defense beneficiaries -Procured office supplies and equipment for six departments maximizing a $30,000budget. -Administered the department safety training on a monthly basis ensuring regulation compliance.
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Education
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Texas A&M University-San Antonio
Bachelor of Business Administration - BBA, Health/Health Care Administration/Management -
2009 - 2012
Palo Alto College
Associate's degree
Community
