Cara Longoria
@caralongoria
Detail-oriented credentialing specialist with 3+ years managing provider credentialing, compliance, and accurate healthcare enrollment records.
United StatesWhat I'm looking for
I’m a Credentialing Specialist with 3+ years of experience managing provider credentialing in healthcare settings, with a focus on regulatory compliance and accurate, up-to-date records. I handle both initial credentialing and recredentialing workflows to support seamless provider network operations.
I’m skilled in verifying provider information across licensure, NPI, insurance, DEA certificates, education, hospital privileges, and board certifications. I also review the National Practitioners Data Bank for adverse actions and conduct documentation reviews to ensure adherence to NCQA and HIPAA standards.
I work confidently with CAQH and credentialing systems like Cactus to maintain credentialing files for committee review. I prioritize timely, accurate application information and support ongoing compliance for physicians added to the network, including a wide range of specialties.
Beyond credentialing, I’ve contributed to patient-centered communication through mentoring parents of premature and micro premature infants at Toledo Children’s Hospital. That experience strengthened how I collaborate, communicate remotely and in person, and maintain a supportive, organized approach for sensitive healthcare needs.
Experience
Work history, roles, and key accomplishments
Provider Credentialing Specialist II
Medical Mutual of Ohio
Jul 2024 - Present (2 years)
Manage initial credentialing and recredentialing for individual practitioners to ensure regulatory compliance. Verify provider information, review the National Practitioner Data Bank, maintain credentialing files in Cactus, and conduct documentation reviews for NCQA and HIPAA standards.
Parent Mentor Program
Toledo Children's Hospital
May 2018 - Present (8 years 2 months)
Mentor parents of premature and micro premature infants to address emotional and parental concerns. Coordinate with hospital staff and facilitate communication between families and healthcare providers to improve the care experience.
Credentialing Specialist
Paramount
Jun 2022 - Apr 2024 (1 year 10 months)
Managed initial credentialing for individual practitioners to ensure regulatory compliance. Verified provider information, reviewed the National Practitioner Data Bank, maintained credentialing files in Cactus, and completed documentation reviews for NCQA and HIPAA standards.
Call Center Agent
Erie Home
Sep 2020 - May 2022 (1 year 8 months)
Provided customer service through inbound and outbound calls, handling inquiries and scheduling appointments. Used multiple software programs to gather information and coordinate schedules, including call transfers and rescheduling.
Oversaw scheduling and coordinated performance across front desk, housekeeping, maintenance, and night laundry departments. Managed invoicing and accounts receivable, supported hiring and training, and provided training and shift coverage.
Provided high-quality customer service and managed guest communications. Completed daily billing and accounts receivable duties with accuracy and timeliness.
Provided customer service and acted as a liaison between customers and departments. Processed transactions on point-of-sale systems and supported merchandising and floor organization.
Education
Degrees, certifications, and relevant coursework
Toledo Technology Academy
High School Diploma, High School
2007 - 2011
Earned a High School Diploma from Toledo Technology Academy, completing the program in 2011.
Tech stack
Software and tools used professionally
Availability
Location
United StatesAuthorized to work in
Job categories
Skills
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