Your Name
Summary
Experienced Provider Enrollment Specialist with amazing self-confidence and a background processing government and commercial payor applications. Offering two years overseeing credentialing for health practitioners and new facilities. Considered a detail-oriented individual with dynamic time management and organizational skills.
Overview
1
1
Certification
Work History
Provider Enrollment Specialist
Amerihealth Caritas Health Plan
Jacksonville, NC
- Used Echo and Excel to maintain over 150 Provider files and file notes.
- Inputted all gathered information and researched data on applicants into computer system using Echo and Excel.
- Communicated with people from various cultures and backgrounds on application process.
- Monitored credentials and contacted practitioners when expiration dates were nearing.
- Contacted insurance carriers to obtain information regarding denials.
- Used Echo and Excel to enter all new details, including provider effective dates into enrollment database.
Team Lead
Maximus, Inc.
Arlington, TX
- Established open and professional relationships with team members which helped resolve issues and conflicts quickly.
- Trained and mentored staff on procedures, compliance requirements and collections techniques.
- Conducted performance reviews and implemented improvement plans.
- Reviewed billing problems, researched issues and resolved concerns.
- Helped employees with day-to-day work and complex problems by applying motivational and analytical strategies.
- Established efficient workflow processes, monitored daily productivity and implemented modifications to improve overall effectiveness of personnel and activities.
- Interacted with customers professionally by phone, email or in-person to provide information and directed to desired staff members.
Supervisor
Carenet
KY, State
- Orchestrated day-to-day operations of billing department, including medical coding, payment posting, accounts receivables and collections.
- Liaised between patients, insurance companies and billing office.
- Adhered to established standards to safeguard all patients' health information.
- Complied with all HIPAA Privacy and Security Regulations to protect patients' medical records and information.
- Enforced operational compliance with state and federal laws and JCAHO standards.
- Trained new employees on multiple medical billing programs and data entry software.
- Gathered information from multiple sources to simplify billing and organize accounts.
- Devised new methods to make workflows more efficient and brought suggestions to attention of Directors.
- Maintained current accounts through aged revenue reporting.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Submitted electronic and paper claims to insurance companies including Medicare, Medicaid and Commercial payers to collect medical payments.
Billing Collector
Unitedhealth Group
Queen Creek, AZ
- Communicated with insurance providers to resolve any denied claims and resubmit.
- Trained new employees on multiple medical billing programs and data entry software.
- Applied charges and updated patient records.
- Completed client requests and advised supervisors of special needs.
- Submitted electronic and paper claims to insurance companies including Medicare and Medicaid to collect medical payments.
- Guarded against fraud and abuse by verifying all coded data accurately reflected services provided.
- Gathered information from multiple sources to simplify billing and organize accounts.
- Verified proper ICD-9 and ICD-10 coding on claims.
- Transferred balances to correct payers.
- Processed insurance company denials by auditing patient files, researching procedures and diagnostic codes to determine proper reimbursement.
- Collected payments and applied to patient accounts.
- Translated and interpreted medical billing codes with strong accuracy to enable swift payment from insurance agencies.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Devised new methods to make workflows more efficient and brought suggestions to attention of the Billing Manager.
- Adhered to established standards to safeguard all patients' health information.
- Prepared accounts with past due balances of more than 120 days and transferred those cases to collection agency.
- Researched and followed up on denied insurance claims.
- Maintained current accounts through aged revenue reporting.
- Assisted patients by determining financial assistance available and setting up payment plans.
- Complied with all HIPAA Privacy and Security Regulations to protect patients' medical records and information.
- Efficiently collected payments and communicated with clients.
Education
High School Diploma -
Middletown High School North
Middletown, NJ06.1992
Skills
- Validation of discrepancies
- Practitioner enrollment
- Appointment Scheduling
- Applicant engagement
- Effective communication skills
- Relationship development
- Supervision
- Team management
- Problem resolution
- Program knowledge in Centricity, Quickbooks and Echo
- Credentialing data coordination
- Resource information
- Documentation and paperwork
- Application Review
- Operational improvement
- Project organization
- Process improvement
- Business operations
- Proficiency in MS Office, Cerner, Medisys and Adobe
Certification
Certified Patient Account Representative (CPAR)
Timeline
Provider Enrollment Specialist
Amerihealth Caritas Health Plan
Team Lead
Maximus, Inc.
Supervisor
Carenet
Billing Collector
Unitedhealth Group
High School Diploma -
Middletown High School North
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