Looking for a job

Samantha Chavez

@samanthachavez

Message

I lead credentialing and payer enrollment operations for large Medicaid managed care provider networks.

United States

Message

What I'm looking for

I'm looking to lead credentialing, provider enrollment, and data-integrity operations where I can improve turnaround times, strengthen audit readiness, develop teams, and support provider activation and billing outcomes.

At Children’s National Hospital–HSCSN, I led credentialing, recredentialing, provider-data integrity, and Medicaid payer enrollment for a 5,000+ provider multispecialty network.

I eliminated 90% of a 400+ file backlog in three months, reduced credentialing turnaround to under 90 days, and cut enrollment gaps to under 12 days. I also reduced enrollment- and credentialing-related claim denials by 30% through collaboration with Claims, Revenue Cycle, and payer stakeholders.

I’ve supervised a 12-person credentialing team, built SOPs and quality controls, trained new specialists, and supported audit readiness across NCQA, CMS, Joint Commission, and payer reviews. My work spans Symplr, QNXT, CAQH, provider enrollment, quality analytics, and process improvement.

Experience

Work history, roles, and key accomplishments

Credentialing Program Lead

Children's National Hospital - HSCSN

Dec 2024 - Jul 2026 (1 year 7 months)

Managed credentialing, recredentialing, and Medicaid payer enrollment for a multispecialty network of 5,000+ providers. Reduced credentialing turnaround from 120+ days to under 90 days and reduced claim denials by 30%.

Credentialing Coordinator

Children's National Hospital - HSCSN

Dec 2023 - Dec 2024 (1 year)

Improved credentialing turnaround by 20% by centralizing tracking and standardizing workflows in Symplr. Served as subject matter expert for Symplr, QNXT, CAQH, and NPDB, and performed primary source verification for 5,000+ providers.

Symplify QNXT CAQH National Practitioner Data Bank (NPDB)Primary Source Verification Training NCQA Compliance Provider Enrollment Escalation Management

Quality Assurance and Analytics Intern

Inova Health System

May 2023 - Dec 2023 (7 months)

Led cross-functional quality improvement initiatives using performance analytics and process improvement methods. Conducted quality audits and performance analyses using Excel, Tableau, Epic, and QuickSight, and applied Six Sigma methods to improve call-light responsiveness by 7%.

Excel Tableau Epic QuickSight Root Cause Analysis Benchmarking Six Sigma Quality Improvement Executive Reporting

Provider Operations Specialist

Fairfax Neonatal Associates - Inova Health System

Dec 2019 - May 2023 (3 years 5 months)

Tracked initial credentialing, enrollments, re-enrollments, and revalidations from submission through payer approval. Conducted provider enrollment, credentialing, and claims processing using Symplr, NPPES, EPIC, and CAQH.

Symplify NPPES Epic CAQH Provider Enrollment Credentialing Claims Processing Liaison Enrollment

Education

Degrees, certifications, and relevant coursework

George Mason University

Master of Healthcare Administration, Healthcare Administration

2021 - 2023

Activities and societies: Community Outreach Chair - Rising Healthcare Leaders

Master of Healthcare Administration with first place in the 2023 GMU MHA Quality Improvement Capstone Project. Served as Community Outreach Chair for Rising Healthcare Leaders.