
Detail-driven Healthcare Support Specialist with extensive experience in referral processing, claims adjudication, care management support, provider enrollment, and high-volume customer service. Proven ability to collect and document data with precision, ensure regulatory compliance, manage complex inquiries, and maintain accurate records across multiple systems. Recognized for delivering seamless coordination of patient services, efficient workflow execution, and exceptional client communication. Committed to promoting continuity of care, operational accuracy, and quality healthcare outcomes.
• Handled customer inquiries via phone, email, and chat with professionalism and empathy while adhering to workflow priorities.
• Interpreted customer concerns, researched account details, and provided accurate resolutions using multiple platforms.
• Maintained detailed account notes and contributed to enhanced customer satisfaction through clear communication and timely follow-through.
• Demonstrated strong multitasking skills while working within fast-paced, metrics-driven environments.
• Conducted claims research, verified benefits, and identified discrepancies to ensure compliance with payer and policy requirements.
• Utilized multiple systems to review documentation, validate coding, and maintain accurate member records.
• Delivered high-quality support by troubleshooting claim issues and escalating cases when necessary.
Coordinated enrollment for employed and contracted healthcare providers, ensuring timely activation with payers, facilities, and regulatory entities.
• Verified and maintained credentialing data to support accurate reimbursement and uninterrupted patient care.
• Played a key role in onboarding rounding providers, ensuring all enrollment components were completed efficiently.
• Monitored compliance requirements, performed data audits, and managed deadlines to prevent delays in provider billing.
• Collected, entered, and documented referral data with a high degree of accuracy, ensuring compliance with internal, state, and federal guidelines.
• Maintained consistent follow-up on referral decisions, communicating updates clearly and professionally.
• Partnered with clinical teams to streamline onboarding and improve the overall referral workflow.
Claims Processing Platforms
Provider Enrollment Databases
Microsoft Office Suite
CRM & Call Center Software
Data Entry & Documentation Tools