Shaneika Sanders
District Heights,MD
Summary
Detail-oriented Provider Enrollment Specialist with 5+ years of experience managing provider credentialing, Revalidation, and payer enrollment for hospitals, physician groups, and allied health providers. Proven ability to ensure compliance with CMS, NCQA, and payer-specific requirements while reducing enrollment turnaround times. Strong communicator with a focus on accuracy, timeliness, and provider satisfaction both remote and on-site environments.
Overview
28
28
years of professional experience
Work History
Delivery Partner
Gopuff
Washington, DC
01.2024 - Current
- Arrive at GoPuff facility, pick up orders, load securely.
- Use the GoPuff Driver app to receive delivery “trips”/orders.
- Navigate to the delivery location, deliver orders safely and in good condition.
- Provide good customer service (friendly, professional).
- Adhere to local traffic laws and safety standards.
- Maintain communication (via app / phone) with GoPuff if there are issues (traffic, order mishaps, etc.)
Billing Specialist-Digitech
Business Promotion Consultants, Inc
Washington, DC
01.2022 - 06.2023
- Processed insurance claims with precise ICD-10 and CPT coding, ensuring timely submission to Medicare, Medicaid, and private insurers.
- Resolved denied claims by identifying errors, correcting discrepancies, and resubmitting for reimbursement.
- Managed patient billing processes, including explaining charges, addressing disputes, and coordinating payment plans while ensuring HIPAA compliance.
- Spearheaded collection efforts, resulting in a 75% increase in monthly revenue for DC Fire EMS.
Client Service Representative-R1
Business Promotion Consultants, Inc
10.2016 - 12.2022
- Analyzed patient survey data using SurveyMonkey, generating reports to support operational improvements.
- Processed claims through platforms such as Waystar and Accurint, while managing correspondence, payment posting, bankruptcies, and collections.
- Developed and trained staff on a new collections process for DC Fire EMS, ensuring adherence to client guidelines.
Client Services
Allied Universal
Washington, DC
04.2014 - 10.2022
- Processed customer service requests via phone support and email support.
- Customized CRM using the most up-to-date tools (i.e., workflows, triggers)
- Noted customer correspondence in CRM to track requests, problems and solutions.
- Cross trained in multiple departments to know all company needs and train new employees.
- Analyzed and updated all necessary changes to daily logs.
Provider Enrollment Specialist-Conduent
Washington, DC
01.2013 - 08.2018
- Reviewed and processed initial and recredentialing applications for providers in accordance with federal, state, and Med Vanta requirements.
- Managed enrollment applications using Medicare (PECOS), Medicaid portals (e.g., EPREP), CAQH, Availity, and various payor-specific platforms.
- Conducted primary source verification for education, licensure, board certification, malpractice, and work history following NCQA, URAC, and regulatory standards.
- Identified and resolved inconsistencies or gaps in credentialing documentation, escalating issues to the Credentialing Manager when necessary.
- Maintained accurate provider data across credentialing databases, including EHR systems and credentialing platforms.
- Ensured proper use of tools such as Modio Health, CAQH, PECOS, and internal spreadsheets for tracking provider status.
- Communicated directly with providers, internal departments, and health plans to gather required documents or respond to inquiries.
- Submitted provider rosters and maintained records for delegated credentialing agreements.
- Collaborated within a remote or in-office team environment to support credentialing operations.
Billing Specialist
Practice Partners, LLC
Washington, DC
06.2010 - 12.2012
- Researched and resolved insurance payment discrepancies, which effectively reduced claim denials and improved overall billing accuracy.
- Processed patient reimbursements and reconciled insurance denials by verifying coding accuracy (ICD-9, CPT) and submitting corrected claims.
Administrative Assistant
Ajilon Staffing Agency-American Airlines Government Affairs
Washington, DC
09.2004 - 05.2010
- Managed travel arrangements and scheduling for the executive team, ensuring seamless operational support.
- Facilitated high-volume client communications and maintained secure records to uphold confidentiality and efficiency.
Manager
Parade of Shoes
Washington, DC
03.1998 - 08.2004
- Assisted in daily business operations, focusing on human resources, customer service, and merchandising to enhance efficiency.
- Recruited, trained, and supervised employees, while conducting performance reviews and coaching for development.
- Managed inventory and scheduled staff to align with sales objectives, adapting merchandise orders to meet demand trends.
Education
Certified Medical Coding & Billing Specialist - Medical Coding & Billing
MedTech College
Washington, DC05.2011
Associate of Science - Criminal Justice
Gibbs College
Vienna, VA02.2007
Skills
Strong time management
Organizational growth
Reliability and punctuality
Effective problem solving
CORE COMPETENCIES
- Provider Enrollment & Credentialing
- Medicare, Medicaid & Commercial Payers
- CAQH ProView Management
- NPI & PECOS Registration
- Payer Applications & Revalidations
- Provider Data Management
- Compliance (CMS, NCQA, URAC)
- Primary Source Verification (PSV)
- Recredentialing & Audits
- Provider Relations & Follow-Up
Timeline
Delivery Partner
Gopuff
01.2024 - Current
Billing Specialist-Digitech
Business Promotion Consultants, Inc
01.2022 - 06.2023
Client Service Representative-R1
Business Promotion Consultants, Inc
10.2016 - 12.2022
Client Services
Allied Universal
04.2014 - 10.2022
Provider Enrollment Specialist-Conduent
01.2013 - 08.2018
Billing Specialist
Practice Partners, LLC
06.2010 - 12.2012
Administrative Assistant
Ajilon Staffing Agency-American Airlines Government Affairs
09.2004 - 05.2010
Manager
Parade of Shoes
03.1998 - 08.2004
Certified Medical Coding & Billing Specialist - Medical Coding & Billing
MedTech College
Associate of Science - Criminal Justice
Gibbs College