Artrese Wilson

Columbus

Summary

Detail-oriented Provider Enrollment Specialist with experience supporting healthcare operations, insurance verification, scheduling, and high-volume customer service environments. Skilled in payer enrollment support, provider relations, data management, and resolving issues efficiently while maintaining compliance and accuracy. Strong background working with cross-functional teams, managing sensitive information, and delivering exceptional service in fast-paced healthcare settings. Proficient in CRM systems, Microsoft Office, and maintaining organized provider and account records.

Professional with in-depth experience in healthcare operations and provider enrollment. Skilled in navigating complex regulatory requirements, ensuring compliance, and streamlining processes for efficiency. Strong focus on team collaboration and achieving results, adaptable to changing needs. Known for exceptional organizational skills, problem-solving abilities, and effective communication.

Overview

years of professional experience

Work History

Provider Enrollment Specialist

Plushcare/Accolade Inc.

02.2024 - 05.2026

Manage the end-to-end enrollment process for physicians and advanced practice providers across all 50 states
Manage and maintain CAQH profiles, ensuring timely re-attestations and accurate information updates.
Maintain and update internal databases (Verifiable, MD Staff, Athena, etc) and payer portals to reflect accurate provider information and support audit readiness.
Established and maintained CAQH accounts, ensuring timely re-attestations and compliance.
Coordinate and submit provider applications for enrollment with commercial and government payers, including
Medicare and Medicaid across multiple states (TX, FL, GA, WI, KY, OH, IN, CA, MI, NC, etc).

Credentialing & Payor Enrollment Specialist

Quantum Health

01.2021 - 01.2024

Conducted comprehensive primary source verifications, including background checks, board certifications, and NPDB searches.
Managed hospital and insurance credentialing documents, streamlining data entry into Verity, PROMIS, Acorn & MDStaff databases.
Coordinated medical licensing processes, overseeing application submissions and renewals.
Expertly handled Medicare and commercial insurance enrollments through NPPES/PECOS and various online portals (Availity, PhiCure, etc.).
Optimized EDI, ERA, and EFT enrollments, maintaining up-to-date provider information across multiple payer portals for accurate billing and payments.

Customer Service Representative

Optum

06.2018 - 01.2021

Managed inbound and outbound calls to coordinate workers’ compensation services, including home health, physical therapy, and MRI appointments.
Scheduled and tracked patient services while ensuring timely communication between providers, patients, and case managers.
Reviewed workers’ compensation cases for accuracy, completeness, and proper documentation prior to service coordination.
Maintained detailed patient and case records within internal systems while ensuring HIPAA compliance and data accuracy.
Collaborated with healthcare providers and internal teams to resolve scheduling issues and support efficient patient care coordination.

Education

HIMT - Certificate of Completion - Health Information Technology

Columbus State Community College

Columbus, OH

06-2017

Skills

Credentialing Software: Verity, PROMIS, Acorn, CAQH, Salesforce (Verifiable)
Commercial Insurance Online Portals (BSC, Aetna, Cigna, Availity)
Microsoft Office Suite (Excel, Word, PowerPoint)
Google Docs, Asana, SharePoint
Creative problem solver

Exceptional communication skills
Strong communication skills
HIPAA compliance awareness
Effective written and verbal communication

Timeline