Provider Enrollment Specialist Resume Samples

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Provider Enrollment Specialists work in the healthcare industry and manage the enrollment of new and existing physicians. Essential functions seen on a Provider Enrollment Specialist resume sample are assessing potential participants, maintaining written assessments, taking part to team meetings, and assisting with the financial eligibility processes. The ideal candidate needs to make display of the following qualifications in their resumes: knowledge of healthcare issues, organizational skills, financial expertise, computer competences, and being able to work under pressure. Education in health and human services with focus on customer service or social work is required.

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1

Provider Enrollment Specialist

Responsible for processing and maintenance of Universal Applications for Enrolled Med and CAQH Data Bases.

  • Processed Enrollment requests submissions to my assigned States Commercial Payers.
  • Managed work log for Application Specialists to begin Enrollment Process.
  • Made follow up calls to Payers for Enrollment to confirm approval status
  • Created W-9 Forms for assigned contracted HCA groups.
  • Completed CAQH Maintenance for assigned HCA Contracted Providers.
  • Assisted with Special Projects.
Candidate Info
4
years in
workforce
4
years
at this job
2

Provider Enrollment Specialist

Responsible for enrolling and credentialing Providers into Texas Medicaid

  • Established relationships with Providers offices to ensure proper handling of documentation
  • Provided follow through with Office Staff to ensure fast and proper handling/processing application
  • Trained and Monitored new staff for quality and professionalism
Candidate Info
11
years in
workforce
7
months
at this job
3

Provider Enrollment Specialist

  • Coordinates credentialing data needed for enrollment, contracting, and other related purposes. Credentialing data includes but not limited to medical degree, (DEA) number, state license, board certifications, CV, malpractice insurance, and state insurance form.
  • Analyzes reports for physician enrollment, re-enrollment and dis-enrollment to measure timely completion in accordance to contract agreements.
  • Revises all system-generated report errors and looks for global issues that can be corrected through process improvement.
  • Develops and maintains relationships with external physicians and Managed Care Health Plans.
  • Developed and administered innovative team building strategies that improved communication, leadership skills and diversity awareness in clinical settings within a 6 month period.
Candidate Info
16
years in
workforce
5
years
at this job
BBA
Health Service Administration
4

Provider Enrollment Specialist

Prepares and submit applications to Medicare and Medicaid for new provider enrollments and existing provider updates; follow up by telephone or in writing, with carriers regarding application status

  • Requests NPI numbers for providers and clinics as necessary and maintain NPI files.
  • Follows up, either by telephone or in writing, with insurance companies and patients regarding the processing of outstanding claims and or appeals
  • Utilize the enrollment database to perform queries and reports for manager
  • Identify issues that require additional investigation and evaluation, validates discrepancies and complete appropriate follow up
Candidate Info
8
years in
workforce
10
months
at this job
AA
Associate of Arts
5

Credentialing Specialist / Provider Enrollment Specialist

  • As Credentialing Specialist, responsible for Ambulatory Surgery Center privileging and re-privileging process for initial and current providers, including primary source verifications and processing.
  • Update and maintain ECHO software for credentialing department including updating provider information, and adding new providers.
  • Run data quality reports and reviews files and online provider databases for accuracy and errors.
  • Coordinate the credentialing and re-credentialing of providers participating in the Integrated Eye Care Network.
  • Responsible for tracking and updating expiring provider credentials including state license, DEA and annual training programs.
  • In the role of Provider Enrollment Specialist, completed ā€˜A to Zā€™ managed care credentialing and re-credentialing for 40+ providers with more than 25 health plans.
  • Conducted follow-ups with health plan credentialing and provider relation representatives on credentialing, re-credentialing and demographic updates.
  • Was responsible for the creation, editing and upkeep of a managed care credentialing manual for the credentialing department.
  • Created and maintained CAQH provider profiles for new and existing providers on an ongoing basis. Reviewed profiles for errors and corrected accordingly.
  • Received positive end of year employee reviews for 2014, 2015, and 2016 while meeting year-end goals.
Candidate Info
13
years in
workforce
3
years
at this job
BA
Expository And Creative Writing
Inter-disciplinary Study
6

PROVIDER ENROLLMENT Specialist- TEAM LEAD

  • Responsible for completion and follow-up of provider applications including Medicare, Medicaid and top commercial payers for multiple states. Able to multi-task and prioritize workload resulting in timely submitting and processing of provider applications. Research insurance issues and effectively communicate with billing staff the progress of approved provider numbers.
  • Develop and maintain strong relationships with clinic and hospital staff to obtain necessary credentialing documents required to complete and submit accurate applications. Communicate and advise the physician, mid-level or designated contact person of sequential steps needed to begin enrollment, through completion.
  • Served as team lead by offering guidance and support to fellow team members. Support Supervisor with various assigned duties and back up as needed. Maintained provider enrollment work load in addition to Team Lead duties
Candidate Info
14
years in
workforce
9
years
at this job
7

Provider Enrollment Specialist

  • Currently maintaining record of 630 individual providers.
  • Communicate and advise hospital CEO or designated contact person of the needed paperwork necessary to begin the application process for new physicians through completion.
  • Contact top insurance plans (government and commercial) to request provider enrollment application packages, and to continue to follow-up with insurance plans by telephone or email until all provider numbers are issued.
  • Validate CAQH attestation as well as CAQH maintenance
  • Follow up on all re-credentiailing & revalidation requests as received.
  • Key all provider demographic and enrollment data into Vistar and Care Computer System
Candidate Info
10
years in
workforce
3
years
at this job
MA
Social Justice
8

Provider Enrollment Specialist II

Verifies provider enrollment application approval with health plans (Medicare, Medicaid)

  • Maintains up to date provider enrollment documentation.
  • Processes 200 to 250 assignments per month while maintaining above a 96% quality rating.
  • Follows up with providers to ensure forms are completed in a timely manner.
  • Completes provider enrollment applications and written requests.
  • Prepares correspondence to send to providers and health plans via fax, email and postal mail.
  • Creates enrollment and provider by practice analytical reports to identify key provider demographic information.
  • Utilizes a tickler filing system to track when signed applications, health plan approvals, and follow ups are to be completed daily.
  • Calculates any open accounts receivables due to the providers from the health plans and resolves any outstanding balances due in excess of 100k for closure.
  • Completes special projects within time frames given by management.
  • Meets or exceeds quality and quantity productivity standards monthly.
Candidate Info
11
years in
workforce
3
years
at this job
HS
High School Diploma
BA
Science
9

Provider Enrollment Specialist

  • Prepare, submit, and follow up on all initial payer applications for government programs and company approved managed care organizations, as well as recredentialing applications for all providers and practice locations
  • Collect and maintain files in relation to credentialing of network providers including current provider licenses, DEA certificates, malpractice insurance, board certifications, and other pertinent forms need for enrollment
  • Advise management team of any potential delays in a providers enrollment and work with billing office staff in resolving billing issues related to payer enrollment issues
  • Routinely review and update provider files and rosters including, but not limited to individual/group CAQH profiles, payer databases, NPI/NPPES, PECOS, and any others
  • Update billing database, Intellicred, once a provider has been approved and assigned provider numbers are obtained
  • Communicate with all necessary internal departments, as well as develop and maintain relationships with individual contacts for government agencies and managed care organizations
  • Maintain consistent contact with providers and practice directors to ensure expectations are clear and requirements are completed in a timely manner
  • Complete other tasks or projects as assigned
Candidate Info
20
years in
workforce
1
year
at this job
AS
Marketing Management
10

Provider Enrollment Specialist

  • Enrolling over 150 provider with over 1100 payer lines for Florida and Georgia
  • Initiating and completing various payer applications specific to their enrollment regulations
  • Perform payer research for specific requirements
  • Maintain relationship between providers and Office Manager ensuring all documentation is received and upon completion of enrollment
  • Maintained accurate documentation in CARE system for progress of enrollment and provider documentation
  • Timely follow up with payers to ensure receipt of application and needs to complete enrollment
  • Update CAQH/PECOS
Candidate Info
14
years in
workforce
1
year
at this job
Accounting/business

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