Chantelle Nunes-Bowen
Covington,GA
Summary
Accomplished in enhancing customer satisfaction and streamlining operations, I leveraged my expertise in medical terminology and exceptional communication skills at Pediatric Associates. Specializing in issue resolution and maintaining confidentiality, my proactive approach resulted in improved patient flow and service delivery, embodying a results-driven work ethic with a focus on achieving tangible outcomes. Healthcare professional with solid foundation in provider enrollment. Recognized for improving enrollment efficiency and ensuring compliance with regulatory standards. Known for fostering team collaboration and consistently achieving successful outcomes through adaptability and reliability. Proficient in credentialing processes and regulatory requirements.
Experienced with managing provider enrollment processes, ensuring timely and accurate credentialing. Utilizes strong communication and organizational skills to enhance workflow efficiency. Knowledge of compliance regulations and documentation management ensures seamless operations.
Overview
14
14
years of professional experience
Work History
Healthcare Customer Experience
Kaiser Permanente
04.2025 - Current
- Research and resolve complex healthcare insurance, provider enrollment, eligibility, and coverage inquiries across commercial, Medicare, and Medicare Advantage health plans.
- Review provider and health plan information to identify discrepancies involving provider demographics, network participation, enrollment status, and effective dates.
- Investigate claims and payment-related issues by reviewing coverage information, provider records, benefit details, and applicable health plan requirements.
- Coordinate with internal departments and cross-functional teams to research provider-related concerns, resolve enrollment discrepancies, and facilitate timely issue resolution.
- Maintain accurate healthcare records, case documentation, research findings, and follow-up trackers to support operational accuracy and audit readiness.
- Analyze healthcare information across multiple systems to identify missing, inconsistent, or outdated records requiring correction.
- Support provider and payer-related escalations by gathering relevant documentation, researching account history, and communicating findings to appropriate departments.
- Utilize Epic, eClinicalWorks, and practice management systems to access, review, and validate healthcare and provider-related information.
- Communicate professionally with members, healthcare providers, and internal stakeholders regarding insurance coverage, provider participation, claims inquiries, and administrative processes.
- Manage high-volume workloads while maintaining attention to detail, meeting service expectations, and prioritizing time-sensitive inquiries.
- Leverage Excel, Google Sheets, and AI tools to organize information, conduct research, analyze data, and improve documentation and workflow efficiency.
- Protect confidential healthcare information while adhering to HIPAA privacy requirements and established organizational procedures.
Healthcare Operations
Pediatric Associates
11.2020 - 04.2025
- Verified patient insurance eligibility, coverage information, and provider participation to support accurate healthcare administration.
- Reviewed patient and provider demographic information, identifying discrepancies and coordinating necessary updates.
- Coordinated with healthcare providers, clinical staff, and administrative teams to resolve documentation and information-related inquiries.
- Managed patient records, referrals, and administrative requests while maintaining confidentiality and compliance with HIPAA requirements.
- Supported provider office operations by organizing medical documentation, updating electronic health records, and maintaining accurate information across healthcare systems.
- Assisted with insurance-related inquiries, authorization documentation, and follow-up on outstanding administrative requests.
- Utilized electronic health record systems and practice management software to retrieve, update, and validate healthcare information.
Provider Services Representative
BroadthPath- BCBSAZ
01.2020 - 11.2020
- Communicate with clinicians, payer representatives, and internal stakeholders regarding enrollment requirements, credentialing status, provider updates, and outstanding documentation.
- Investigate provider enrollment discrepancies and support payer escalations by supplying accurate enrollment records, effective dates, and supporting documentation.
- Collaborate with claims and revenue cycle teams to investigate enrollment-related claim denials, payment discrepancies, and provider participation issues.
- Maintain accurate provider information within payer portals and internal databases, reconciling records against submitted roster files.
- Utilize AI tools, including ChatGPT and AI-assisted workflows, to analyze data, identify discrepancies, validate spreadsheet information, and improve operational efficiency.
- Identify opportunities to streamline recurring roster submissions through spreadsheet automation, standardized tracking tools, and documented procedures.
- Prepare monthly operational reports highlighting roster accuracy, enrollment activity, pending requests, turnaround times, and provider data discrepancies.
Healthcare Operations
Centers Plan for Healthy Living
11.2019 - 01.2020
- Perform quality assurance reviews to identify and correct enrollment and roster errors before submission, supporting accurate payer records and reducing downstream claims issues.
- Review health plan participation requirements to ensure provider information aligns with payer-specific enrollment and network policies.
- Coordinate follow-up activities for incomplete applications, missing documentation, and pending provider enrollment requests.
- Investigate rejected or returned roster submissions, determine the cause of discrepancies, and coordinate corrections before resubmission.
- Maintain organized records of payer correspondence, enrollment confirmations, provider updates, and supporting documentation.
- Compare historical and current provider data to identify changes in network participation, practice affiliations, and enrollment status.
- Track provider onboarding milestones and communicate potential delays that could affect clinician availability or billing readiness.
Customer Service Representative
AT&T
Sunrise, FL
11.2018 - 10.2019
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Responded to customer requests for products, services, and company information.
- Developed strong product knowledge to provide informed recommendations based on individual customer needs.
Customer Service Representative
CallHub Solution
09.2018 - 10.2018
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Maintained up-to-date knowledge of product and service changes.
- Provided excellent customer care by responding to requests, assisting with product selection and handling ordering functions.
Member Service Representative
Gonzo Marketing- MDwise
05.2018 - 08.2018
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Assisting members with logging into and understanding their online health account
- Provide medical benefits and claims information
- Enhanced customer satisfaction by efficiently addressing and resolving inquiries and concerns.
Customer Service Representative
Infinity Sales Group
Boca Raton, FL
05.2017 - 04.2018
- Responded to customer requests for products, services, and company information.
- Developed strong product knowledge to provide informed recommendations based on individual customer needs.
- Developed rapport with customers through active listening skills, leading to higher retention rates and positive feedback from clients.
Customer Service Representative
H&M Hennes & Mauritz
Pembroke Pines, FL
12.2012 - 05.2017
- Greeted customers and helped with product questions, selections, and purchases.
- Developed strong relationships with repeat clients, leading to increased loyalty and return visits.
- Conducted product demonstrations to highlight features and benefits, increasing customer interest.
Education
High School Diploma -
St. Hugh's High School Jamaica
06-2009
Skills
- Clinician Enrollment & Payer Operations
- Provider Credentialing Support
- Health Plan Roster Management
- Commercial Health Plan Enrollment
- Provider Additions & Terminations
- Payer Escalations & Claims Support
- Roster Reconciliation
- Insurance Network Operations
- Data Validation & Accuracy
- Microsoft Excel
- Google Workspace
- Provider Enrollment & Payer Systems
- Healthcare Operations
- AI & Workflow Automation
- Healthcare Technology
- Provider Credentialing Systems
- Data Management & Roster Reconciliation
Accomplishments
- Recognized as Employee of the Month for outstanding performance and commitment to service excellence
- Demonstrated strong data management and documentation skills while navigating multiple healthcare information systems
- Maintained attention to detail when reviewing, updating, and documenting sensitive healthcare and insurance information
Timeline
Healthcare Customer Experience
Kaiser Permanente
04.2025 - Current
Healthcare Operations
Pediatric Associates
11.2020 - 04.2025
Provider Services Representative
BroadthPath- BCBSAZ
01.2020 - 11.2020
Healthcare Operations
Centers Plan for Healthy Living
11.2019 - 01.2020
Customer Service Representative
AT&T
11.2018 - 10.2019
Customer Service Representative
CallHub Solution
09.2018 - 10.2018
Member Service Representative
Gonzo Marketing- MDwise
05.2018 - 08.2018
Customer Service Representative
Infinity Sales Group
05.2017 - 04.2018
Customer Service Representative
H&M Hennes & Mauritz
12.2012 - 05.2017
High School Diploma -
St. Hugh's High School Jamaica