Lisa Carter
Lake Alfred,FL
Summary
To obtain a challenging and responsible position where my education, experience and skills set can be used to enhance business and foster opportunities for growth
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.
Overview
28
28
years of professional experience
Work History
Sr. Credentialing Provider Enrollment Specialist
Tower Health – Reading Hospital
West Reading, PA
07.2016 - 12.2025
- Submits all initial provider enrollment applications to non-delegated contracted insurance payors.
- Follows-up with payors after submission on payor enrollment applications to confirm receipt of applications and the completion of application.
- Effectively communicate to management on urgent issues within the enrollment processes with payor applications not processed and approved timely.
- Responds to inquiries from payors and departments within Tower Health regarding provider enrollment.
- Completes and submits all recredentialing and revalidation request from payors. 3-4 recredentialing applications a month
- Uploads and stores approval letters, emails and roster to the enrollment database.
- Documents accurate records and notes in the database for follow-ups, changes, missing information, approvals, etc.
- Ensures provider demographic changes are communicated to all contracted payors timely.
- Research and escalates issues as needed.
- Provides new and existing team members with ongoing department training for current and updated policies and procedures.
- Participates in all onboarding calls for newly hired providers.
- Assigns tasks for the creation of database shell to establish records for new hires, groups, and locations to the Credentialing Specialists.
- Reviews missing provider data identified on monthly reports and corrects data gaps.
- Maintains and updates all provider and demographic data in PECOS, CAQH, NPPES and Promise.
- Facilitates weekly meetings with each enrollment specialist.
- Reviews department email inbox, faxes, voicemails and assigns tasks to the appropriate team members.
- Advises and assist in establishing workflow process implementation for the Provider Enrollment and Credentialing team.
- Serves as a liaison between departments and practices and health plans.
- Handle new practices notifications to the payors, completed Medicare and Medicaid group applications, Add/Change addresses
- Worked with Smartsheet
- Remote
Credentialing and Enrollment Specialist
Tower Health – Reading Hospital
West Reading, PA
01.2005 - 06.2016
- Submits all initial provider enrollment applications to non-delegated contracted insurance payors.
- Follows-up with payors after submission on payor enrollment applications to confirm receipt of applications and the completion of application.
- Effectively communicate to management on urgent issues within the enrollment processes with payor applications not processed and approved timely.
- Responds to inquiries from payors and departments within Tower Health regarding provider enrollment.
- Completes and submits all recredentialing and revalidation request from payors.
- Uploads and stores approval letters, emails and roster to the enrollment database.
- Documents accurate records and notes in the database for follow-ups, changes, missing information, approvals, etc.
- Ensures provider demographic changes are communicated to all contracted payors timely.
- Research and escalates issues as needed.
- Provides new and existing team members with ongoing department training for current and updated policies and procedures.
- Participates in all onboarding calls for newly hired providers.
- Assigns tasks for the creation of database shell to establish records for new hires, groups, and locations to the Credentialing Specialists.
- Reviews missing provider data identified on monthly reports and corrects data gaps.
- Maintains and updates all provider and demographic data in PECOS, CAQH, NPPES and Promise.
- Facilitates weekly meetings with each enrollment specialist.
- Reviews department email inbox, faxes, voicemails and assigns tasks to the appropriate team members.
- Advises and assist in establishing workflow process implementation for the Provider Enrollment and Credentialing team.
- Serves as a liaison between departments and practices and health plans.
- Remote
- Developed training materials for new staff on enrollment systems and protocols, improving onboarding efficiency.
- Implemented feedback mechanisms to assess enrollment process effectiveness and drive continuous improvement efforts.
Billing Specialist
Tower Health – Reading Hospital
West Reading, PA
08.2003 - 12.2004
- Entered all identifying insurance payments.
- Processed refunds for patient and insurance companies.
- Contacted insurance companies and departments within the hospital to expedite payments.
- Resolved outstanding issues.
- Verified accuracy of accounts payable payments, resulting in 90% reduction in payment errors and check reissues.
- Reviewed and verified insurance claims for accuracy and compliance.
- Trained new staff on billing procedures and software systems effectively.
- Researched and resolved billing discrepancies to enable accurate billing.
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
- Assisted colleagues in resolving complex billing issues, promoting teamwork and knowledge sharing within the department.
Customer Service Specialist
Tower Health – Reading Hospital
West Reading, PA
03.2001 - 08.2003
- Answered 60-75 calls per day.
- Made outboard calls to patients to resolve outstanding balances.
- Offered payment arrangements and assistance for State Provided insurance.
- Accurately documented, researched and resolved customer service issues.
- Improved customer service and patient relations.
- Assisted supervisor and co-workers in various tasks.
- Resolved customer inquiries efficiently, ensuring high satisfaction levels.
- Mentored junior staff, fostering a collaborative and knowledgeable team environment.
- Handled escalated calls calmly, finding resolutions that satisfied both the company and the customer''s needs.
Records Research Department
Sovereign Bank
Reading, PA
01.1998 - 01.2001
- Entered request for copies of checks.
- Handled all incoming calls. 40-50 per Day
- Assisted customers with all aspects of personal banking needs.
- Assisted team leader to achieve monthly goals and set personal goal.
Education
Diploma - General Studies, High School Diploma
Reading High School
Reading, PA06.1992
Skills
- Working knowledge of Microsoft Office applications: Word, Excel, and Outlook
- Data Analysis, training, supervision, HIPAA, PA-DOH, CMS, PAMA, Provider Enrollment, CAQH, NCQA, Cactus, Joint Commission, Medical Staff, Pecos, Navinet, Availity and internet research
- Strong communication skills
- Effective written and verbal communication
- Leadership qualities
- Data entry proficiency
- Special projects
- Physician enrollment
- Credentialing
- Practitioner enrollment
- Re-credentialing request follow up
- Provider enrollment expertise
- Knowledgeable in sProvider (Cactus)
Timeline
Sr. Credentialing Provider Enrollment Specialist
Tower Health – Reading Hospital
07.2016 - 12.2025
Credentialing and Enrollment Specialist
Tower Health – Reading Hospital
01.2005 - 06.2016
Billing Specialist
Tower Health – Reading Hospital
08.2003 - 12.2004
Customer Service Specialist
Tower Health – Reading Hospital
03.2001 - 08.2003
Records Research Department
Sovereign Bank
01.1998 - 01.2001
Diploma - General Studies, High School Diploma
Reading High School
10 Year Service Award
Received 10 Years Service Award