1. SOLIDEL CASTRO
3218 Barker Avenue, Apt. 1N, Bronx, NY 10467
Cell: (347) 778-8389 Email: sc83170@gmail.com
https://www.linkedin.com/in/solidelcastro
CAREER PROFILE
CAREER FOCUS: MANAGER OF PROVIDER DATA -–STAFF TRAINER – QUALITY CONTROL SUPERVISOR
Highly analytical, detail oriented and personal administrative professional with extensive experience in the
healthcare industry with a proven track record of enhancing quality control, managing and testing cases in
databases, and training/supervising employees for the 1199 National Benefit Fund. Strong leadership,
communication skills, and organizational abilities. Ability to implement end to end quality process. Proven track
record of achieving deliverables. Prior experience in provider credentialing, patient verification and eligibility of
benefits, claims review, and patient scheduling. Strong knowledge of provider data systems. Bilingual in
English/Spanish.
COMPETENCIES
● ​Quality Improvement ● Staff Training ● Team Supervision
● ​Test Scripts ● Problem-Solving ● Quality Control
● ​Microsoft Office Tools ● Provider Relations ● Customer Service
PROFESSIONAL EXPERIENCE
1199 National Benefit Funds, New York, NY 2000-Present
Provider Relations Department – Data Management and Integrity Unit
Quality Control Reviewer – Level III (2011-Present)
Identify and resolve data process performance and electronic claim payment inefficiencies while formulating
strategy recommendations for improvements.
Quality Control
● Review and perform troubleshooting of claim processing edit inquiries, partnering with the Fund’s
internal and Hicksville claims departments.
● Audit data accuracy of participating and non-participating providers’ correspondence and claims-related
inquiries.
● Create and prepare weekly and monthly data trends and test scripts as requested.
● Maintain daily audit logs via Microsoft spreadsheets.
● Assist Quality Control Review II staff with functions and projects assigned by management.
STAFF TRAINING
● Plan and deliver comprehensive departmental training to new and exist employees.
● Conducted refresher training sessions for Cactus-Data Management application for 5-12 staff members
on a 3-month probation period. Organized and delivered training materials: manuals, customized
curricula, guides and sample exercises. Assisted management team on work proficiency and
evaluations.
Quality Control Reviewer – Level II (2009-2011)
Conducted staff training/coaching and audits pertaining to data management/integrity and claim performance.
Quality Control
● Updated provider demographic changes/contract status, in addition to provider information from HMS
Medicaid overpayment recovery vendor.
● Assisted with tracking inquiries, staff production and monthly departmental trends in Microsoft Access
and Excel applications.
Staff Training & Supervision
● Partnered with Training & Development for QNXT upgrade sessions, including Team Building Skills.
Assisted with group training sessions for all staff members. Created the QNXT manual and Fund
Provider Demographic Change Form.

2. ● Delegated staff assignments and projects.

3. SOLIDEL CASTRO - 2
Chief Clerk (2006-2009)
● Analyzed and verified accurate provider data information. Initiated closure of terminated provider
records for in-network and out-of-network providers. Rectified discrepancies for directory publication.
● Completed Microsoft Office tool classes including MS Word, Excel and PowerPoint.
Data Entry Clerk (2000-2006)
● Updated provider records in Syntonics, Cactus Trinity II and QNXT Medical for in-network and
out-of-network providers. Collaborated with Member’s Choice Credentialing Unit to ensure all provider
credentials complied all regulatory authorities.
● Performed application tracking and review; maintained current state licenses, DEA licenses,
malpractice liability insurance and board certifications.
Local 32BJ-144 SEIU Health & Pension Funds, New York, NY 1997-2000
Home Care Division – Referral Department
Intake Referral Clerk/Counselor
● Assisted RN’s in responding to 30-50 member calls daily and scheduling medical provider referrals
related to health conditions and symptoms. Counseled walk-in members for provider referrals.
● Gained knowledge of medical terminology, referral processes, office procedures, and health insurance.
● Promoted from Bilingual Receptionist (1997-1999).
EDUCATION
Medical Administration, Monroe College, Bronx, NY 2014
Diploma, Cathedral High School, New York, NY 1993
CONTINUING​ ​EDUCATION
PowerPoint for Business 2013 (Intermediate) Certificate, New York, NY 2016
TECHNICAL SKILLS
Microsoft Office: Word, Excel and PowerPoint. Provider data systems: QNXT Medical and QNXT Dental 4.8,
Electronic 837 tool database, Call Tracking and Cactus (Trinity II) 3.12.

4. SOLIDEL CASTRO
3218 Barker Avenue, Apt. 1N, Bronx, NY 10467
Cell: (347) 778-8389 Email: sc83170@gmail.com
https://www.linkedin.com/in/solidelcastro
To Whom It May Concern:
I am seeking an opportunity with your organization based upon my experience in the healthcare industry in the
areas of claims quality assurance, database control, provider relations, and training/supervising of employees
for the 1199 National Benefit Fund.
You will find that I possess strong leadership, communication skills, and organizational abilities, with the ability
to implement end-to-end quality process, with a proven track record of achieving deliverables. I also have prior
experience in provider credentialing, patient verification and eligibility of benefits, claims review, and patient
scheduling.
Through these experiences, I have been recognized for my strong analytical, quantitative ,and supervisory
skills, as well as my computer literacy in databases and provider software. As a team player and team leader, I
have readily collaborated with others to meet objectives and achieve deadlines.
I am excited about the opportunity of making a substantial contribution to your company and look forward to
developing my professional skills and knowledge.
My salary requirements are flexible based upon the requirements of the position and the compensation
package.
Sincerely,
Solidel Castro