Alisha Pinales
@alishapinales
Credentialing and payer enrollment professional ensuring compliant provider onboarding.
United StatesWhat I'm looking for
I’m an experienced healthcare professional with more than 22 years in provider credentialing, payer enrollment, provider relations, case management, patient access, and healthcare administration. I coordinate credentialing and recredentialing for physicians and allied health providers while ensuring compliance with NCQA, CMS, Medicare, and Medicaid requirements.
I’m known for organization, accuracy, and building strong relationships with providers and internal stakeholders. From primary source verification (CAQH, NPDB, OIG, SAM) to maintaining audit-ready provider files and managing expiring documentation, I handle multiple providers and deadlines while supporting internal and external audits.
Experience
Work history, roles, and key accomplishments
Coordinate credentialing, recredentialing, and payer enrollment for hospitals, clinics, physicians, and allied health providers while maintaining audit-ready documentation. Perform primary source verification and support payer roster submissions and credentialing committee materials.
Coordinate discharge planning and help ensure continuity of care from admission through discharge. Schedule and arrange patient services and support patients and families with transportation and community resources.
Eligibility Analyst
Integrated Health Management Services
Jan 2015 - Feb 2017 (2 years 1 month)
Process Medical, State Disability, and Medicare applications and verify financial information to determine eligibility for assistance programs. Collect, analyze, and summarize financial data.
Patient Care Secretary
Gentiva Hospice
Sep 2013 - Jul 2014 (10 months)
Support hospice interdisciplinary meetings and monitor recertification periods. Coordinate admissions and operational logistics including prescriptions, transportation, DME, schedules, and timesheets.
Lead Registration & Credentialing
San Joaquin Community Hospital
Jan 2001 - Dec 2011 (10 years 11 months)
Register emergency and outpatient surgery patients, verifying insurance and physician orders, and audit patient charts for accuracy and compliance. Manage physician credentialing and related operational activities including licenses and required screenings.
Volunteer Hotline Representative
Assistance Correctional Administration
Serve as a hotline representative as a volunteer for correctional administration support.
Education
Degrees, certifications, and relevant coursework
Grand Canyon University
Bachelor of Health Care Administration, Health Care Administration
Currently enrolled in a Bachelor of Health Care Administration program at Grand Canyon University.
San Joaquin Valley College
Health Care Administration Certification, Health Care Administration
1996 -
Earned a Health Care Administration certification at San Joaquin Valley College in 1996.
Summit Bible College
Associate Degree
Completed an associate degree at Summit Bible College in 2019.
Tech stack
Software and tools used professionally
Availability
Location
United StatesAuthorized to work in
Job categories
Skills
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