Roslyn N. Jones

• Reduced errors in provider applications with meticulous attention to detail and thorough review procedures.
• Implemented quality control measures to identify areas for improvement in the enrollment process, resulting in reduced processing time.
• Contributed towards policy updates by sharing insights from hands-on experience dealing with unique or challenging enrollment scenarios.
• Troubleshot technical issues related to the online enrollment system, providing prompt resolutions for providers and internal stakeholders alike.
• Submitted Government and Commercial enrollment for Texas and Maryland Payers.
• Completed follow up on all submitted application within payer specific timeframes.
• Established strong relationships with providers through clear communication and prompt assistance during the enrollment process.
• Handled escalated enrollment cases with professionalism and tact, ensuring positive outcomes for both providers and the organization.
• Managed high-volume caseloads effectively, prioritizing tasks to meet strict deadlines consistently.
• Prepared and processed provider enrollments with Medicare and Medicaid in multiple states.

• Completed Out of State Medicaid Projects for GA and AL.
• Completed and submitted enrollment applications to government and commercial payers for new and existing provider.
• Created and updated CAQH accounts with group practice locations, malpractice and credentialing contacts.
• Followed up with payer to gain enrollment status on submitted applications.
• Updated Standard Operating Procedures with any and all changes for payers.
• Contacted insurance carriers to obtain information regarding denials.
• Conversed effectively with various parties on daily basis using polished interpersonal and active listening skills
• Managed high-volume caseloads effectively, prioritizing tasks to meet strict deadlines consistently.

• Conducted primary source verifications such as background checks and board certifications.
• Received and evaluated applications to look for missing and inaccurate information.
• Obtained NPI numbers for providers and facilities and updated existing profiles.
• Enrolled providers and Medicaid, Medicare and private insurance plans.

Responsible for and processing Payer Applications for all Government and Commercial Payers. Resolve billing issues related to enrollment.

• Maintained accurate files, records and credentialing documents in well-maintained databases using ECHO/Symed.
• Communicated effectively with various parties each day using polished interpersonal and active listening skills.
• Received and evaluated applications to look for missing and inaccurate information.
• Enrolled providers and Medicaid, Medicare and private insurance plans.

• Completed Medicare Revalidations for all states.
• Created/Updated CAQH Proview accounts. Work all claim denials with
  amounts $25,000 and up.
• Submited enrollment application for any claims denied due to not being enrolled with payer, expired documents and deactivations.

• I mailed payer enrollment packet to new providers.
• Enrolled provider with all Government and Commercial payers
  contracted within the state he/she would be working. I followed up on any outstanding credentialing documents.
• I verified certification of all enrolled providers prior to submission to payers. Created/updated CAQH Proview accounts
  for all providers enrolled.
• Verified NPPES Registry to make sure taxonomy code matched certification to ensure claims
  would not be denied/rejected.
• Sent all approved enrollment provider numbers to our Billing team on a weekly basis.
• Worked all denied claims on a weekly basis.

• Responsible for and processing Payer Applications which includes but not limited to Medicare, Medicaid, Blue Cross,
  local HMO’s etc.
• Processed all new and established provider/group Payer applications in accordance with policies and
  procedures which includes but in not limited to: review, completion, highlighting and mailing of applications to Providers for Signature and to Payers for processing.
• Updated Provider/Payer records in Provider Enrollment System.
  Performs duties in accordance with defined policies and procedures and meets departmental Service Level Agreements.
• Provided excellent Customer service to all external and internal customers.