Calie Dethrow
St Louis,MO
Summary
Detail-oriented and mission-driven Provider Enrollment & Credentialing Specialist with 5+ years of experience in payer enrollment processes for Medicaid, Medicare, and commercial plans. Skilled in managing end-to-end enrollment workflows, researching state-specific requirements, and maintaining accurate tracking systems while fostering strong payer relationships. Known for organization, initiative, and clear communication with providers and payers to ensure timely, accurate submissions.
Overview
6
6
years of professional experience
Work History
Sr. Health Plan Enrollment Coordinator
Firstsource
Saint Louis, MO
02.2023 - 12.2025
- Researched payer enrollment requirements by state, including forms, supporting documentation, and regulations for Medicaid, Medicare, and commercial payers.
- Prepared and submitted complete enrollment requests for individual and group applications, ensuring accurate and timely submissions from application retrieval through provider notification.
- Followed up with providers and insurance companies via phone, email, and online portals to gather information and monitor enrollment status.
- Maintain and update provider records including CAQH profiles, NPPES/NPI, DEA, licenses, and demographic data.
- Updated and maintained provider enrollment trackers and credentialing databases to ensure data integrity and accessibility for stakeholders.
- Remote
Enrollment Specialist
Emerest Healthcare
Saint Louis, MO
12.2019 - 01.2023
- Managed payer enrollment processes, ensuring applications were complete and compliant with payer-specific requirements.
- Communicated with providers and payers to obtain necessary documentation and clarify requirements.
- Managed ongoing updates to provider profiles, including licenses, certifications, demographic changes, and recredentialing documentation.
- Handled updates to provider profiles and documentation while maintaining confidentiality and compliance.
- Ensured enrollment applications were complete, accurate, and compliant with payer-specific requirements prior to submission.
- Remote
- Maintained accurate patient records in compliance with healthcare regulations.
- Educated patients on available services and benefits effectively.
- Resolved patient inquiries regarding enrollment status and documentation requirements.
- Handled new enrollments by entering customers' data and reviewing information.
- Performed data entry and maintained accurate records of student enrollment information.
- Listened to and understood customers' needs, explained and discussed options and outlined best-fit services.
Education
Beaumont High School
Saint Louis , MOSkills
- Payer Enrollment Processes
- Provider Enrollment
- Demographic Updates
- Researching State-Specific Payer Requirements
- Google Suite Proficiency
- Data Entry
- Credentialing System Management
- Enrollment processes optimization
- Scheduling appointments
- Enrollment verification
Timeline
Sr. Health Plan Enrollment Coordinator
Firstsource
02.2023 - 12.2025
Enrollment Specialist
Emerest Healthcare
12.2019 - 01.2023
Beaumont High School