Amber Sutton
Kernersville,NC
Summary
Dynamic Provider Enrollment Specialist with a proven track record at TriWest Healthcare Alliance, excelling in streamlining processes and enhancing user experience. Strong communication skills and awareness of HIPAA compliance led to improved enrollment efficiency. Recognized for implementing data management systems that expedited application submissions and resolved payer issues effectively.
Overview
4
4
years of professional experience
Work History
Provider Enrollment Specialist
TriWest Healthcare Alliance
12.2023 - 04.2025
- Facilitated seamless transitions between different stages of the enrollment process by maintaining open lines of communication among various departments involved in provider services operations.
- Troubleshoot technical issues related to the online enrollment system, providing prompt resolutions for providers and internal stakeholders alike.
- Streamlined provider enrollment processes by implementing efficient data management systems.
- Assisted providers with navigating online portal systems, enhancing user experience, and expediting application submissions.
- Retains records related to completed CMS applications
- Maintained provider demographics in all applicable enrollment systems
- Added providers to all applicable systems and maintains information to ensure claims are held/released based on the status of enrollment
- Performs follow-up with Centers for Medicare & Medicaid Services (CMS), and other payers via phone, email, or website to resolve any Payer Enrollment issues
- Managed over 60 calls, emails, and faxes from providers per day.
Quality Assurance Specialist
Bank of America
10.2021 - 12.2023
- Provided regular updates to team leadership on quality metrics by communicating consistency problems or production deficiencies.
- Ensured product compliance with industry regulations by staying up-to-date on relevant standards and guidelines, implementing necessary changes to maintain conformance.
- Enhanced customer satisfaction by addressing reported issues promptly and providing effective solutions.
- Optimized workflow efficiency by introducing automation tools into the QA process where appropriate.
- Educated employees on specific QA standards and confirmed maintenance of standards.
- Managed over 60 calls, emails, and faxes per day from providers.
Education
High School Diploma -
Robert B Glenn
Kernersville, NC06-2013
Skills
- Strong communication skills
- HIPAA compliance awareness
- Effective written and verbal communication
- Leadership qualities
Timeline
Provider Enrollment Specialist
TriWest Healthcare Alliance
12.2023 - 04.2025
Quality Assurance Specialist
Bank of America
10.2021 - 12.2023
High School Diploma -
Robert B Glenn
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