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
21
21
years of professional experience
Work History
Provider Enrollment Specialist
Tufts Health Plan
04.2023 - Current
Facilitated seamless transitions between different stages of the enrollment process by maintaining open lines of communication among various departments involved in provider services operations.
Troubleshot technical issues related to the online enrollment system, providing prompt resolutions for providers and internal stakeholders alike.
Streamlined provider enrollment processes by implementing efficient data management systems.
Assisted providers with navigating online portal systems, enhancing user experience and expediting application submissions.
Reviewed contracts thoroughly to ensure adherence to organizational policies and guidelines before finalizing provider agreements.
Handled escalated enrollment cases with professionalism and tact, ensuring positive outcomes for both providers and the organization.
Communicated effectively via telephone, email, and in person with prospective customers.
Audited provider information regularly to ensure accuracy and completeness of documentation, reducing potential risks associated with noncompliance.
Coordinated closely with credentialing teams to verify provider qualifications, maintaining high standards of care within the organization.
Established strong relationships with providers through clear communication and prompt assistance during the enrollment process.
Dispatcher/Customer Service lead
WOW! Internet Cable and Phone
04.2018 - 04.2023
Residential Dispatch Support Specialist is responsible for answering incoming calls from technical operations and customer care regarding residential customer accounts.
Duties and Responsibilities:
Answer inbound calls and text messages providing support for technical operations for installation and service activities for multiple billers
Troubleshoot and/or make account corrections, modifications, and/or product additions
Assist with CPE equipment, WOW! product provisioning and provisioning escalations
Answer inbound calls with requests from Customer Care and the residential sales teams for customer appointment ETA s, safety escalations, same day appointment requests, future day move-up requests and complaints regarding premise damage, incomplete installation
Complete work orders and enter necessary data (i. e. equipment inventory numbers, arrival/completion times)
Provide Technician troubleshooting for Ultra and Legacy equipment provisioning issues
Provide inbound support to customer care agents for customer scheduling complaints
Reschedule work orders per Technician requests
Maintain ongoing customer contact to keep appointments on track
Follow established processes and procedures for service outs, outages, missed appointments and customer complaints; provide thorough follow-up via ongoing customer contact
Update billing system notes on an ongoing basis
Address market-specific email submissions constantly to ensure customer satisfaction
Data Entry Specialist
Express Scripts
11.2016 - 12.2017
Handled typing in customer information provided directly into an electronic format, and making sure everything was within HIPPA guidelines.
Ability to perform repetitive tasks with a high degree of accuracy
Comfortable working independently with minimal supervision
Customer Service Lead
24 Hour Fitness
07.2004 - 01.2014
1. Conferring with customers by telephone or in person in order to provide information about products and services, to take orders or cancel accounts, or to obtain details of complaints.
2. Keeping records of customer interactions and transactions, recording details of inquiries, complaints, and comments.
3. Resolving customers service or billing complaints by performing activities such as exchanging merchandise, refunding money, and adjusting bills.
4. Checking to ensure that appropriate changes were made to resolve customers problems.
5. Referring unresolved customer grievances to designated departments for further investigation.
6. Determining charges for services requested, collect deposits or payments, and/or arrange for billing.
Adaptive Curriculum Special Education Teacher at Savannah-Chatham County Public School SystemAdaptive Curriculum Special Education Teacher at Savannah-Chatham County Public School System