Tramayne McCray-Grosvenor
Summary
Dynamic Provider Enrollment Specialist with a proven track record at AmeriHealth Caritas, excelling in regulatory compliance and data analysis. Adept at resolving complex claims issues and enhancing documentation accuracy, I leverage strong analytical skills and attention to detail to drive efficiency and uphold high standards in claims processing.
Overview
10
10
years of professional experience
Work History
Provider Enrollment Specialist
AmeriHealth Caritas
12.2022 - Current
- Coordinate the provider mailing for all claims in the invalid provider queue that could not be processed due to missing or invalid information.
- Research and resolve returned checks and provider mail, and complete department reports and logs as assigned.
- Reviewed documentation to ensure adherence to company standards and regulations.
Claims Representative
Sallie Mae
11.2018 - 12.2021
- Reviewed claims for accuracy and compliance with company policies.
- Processed a high volume of claims efficiently while maintaining quality standards.
- Documented changes in claim statuses using specialized software systems.
Claims Specialist
Bank of America
12.2015 - 11.2018
- Investigated complex or high-value claims to identify discrepancies and fraud indicators.
- Identified trends in rejected claims that could indicate system errors or fraudulent activity.
- Documented specific claims by completing and recording forms, reports and logs.
Education
High School Diploma -
NEWARK HIGH SCHOOL
Newark, DE06-2000
WESLEY COLLEGE
Dover, DESkills
- Provider enrollment
- Claims processing
- Regulatory compliance
- Data analysis
- Documentation accuracy
- Microsoft Word/Excel/PowerPoint/SharePoint
- Data entry, facets, CRM, Jiva, common query, IPD, Macess, Cactus, EXP
- Credentialing
Timeline
Provider Enrollment Specialist
AmeriHealth Caritas
12.2022 - Current
Claims Representative
Sallie Mae
11.2018 - 12.2021
Claims Specialist
Bank of America
12.2015 - 11.2018
High School Diploma -
NEWARK HIGH SCHOOL
WESLEY COLLEGE
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