payer enrollment specialist ii resume example with 10+ years of experience

Jessica Claire
, , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
Home: (555) 432-1000 - Cell: - - : - -

Highly Accomplished, Stellar Service-Certified Team Leader who makes sound decisions to reflect positively on multi-site operations in alignment with a company’s vision, value, and goals. Top Performer who offers solutions-centric critical thinking for insightful, change-oriented results with an ongoing awareness of cutting-edge technology and industry trends. Visionary Professional who rises above challenges to improve the bottom line and achieve winning outcomes, including quickly adapting to evolving scenarios. Excellent Communicator who develops synergistic relationships with cross-geographical decision-makers, on / offshore teams, and customers, and who leads peers by example and with ethics and integrity to optimize safety, security, quality, and policy initiatives. Career Highlights Include: Consistently serving as a key driver of company-wide goal achievement. Cross-functionally collaborating with peers to deliver high-quality products/services. Achieving record-breaking customer satisfaction rankings and bottom-line improvements. Providing hands-on support – always willing to “go the extra mile” to surpass the status quo.

  • Respected Customer- and Client-Focused Team Builder Committed to Significantly Improving Customer
  • Microsoft Office (Word, Excel, PowerPoint, Outlook) GoToMeeting NetSuite Types 60+ WPM
  • Healthcare Knowledge
  • Special Projects
  • Physician Enrollment
  • Reporting and File Reviews
  • Re-Credentialing Request Follow up
  • Team Meeting Participation
  • Telephone Etiquette
  • Recordkeeping and Data Input
  • Active Listening
  • Organizational Skills
  • Team Building
  • Conflict Resolution
  • Relationship Building
  • Training & Development
  • Problem Resolution
  • People Skills
  • Microsoft Office
  • Friendly, Positive Attitude
  • Planning & Organizing
  • Team Management
  • Reliable & Trustworthy
  • Supervision & Leadership
  • Customer Service
  • Report Preparation
  • Form Completion and Submission
  • Service Oriented
  • Verbal and Written Communication
  • Telephone and Email Skills
  • Applicant Support and Service
  • Application Assessment
  • Effective Written and Verbal Communication
  • Data Management
  • Critical Thinking
  • Maintenance & Repair
  • Computer Skills
  • Good Work Ethic
06/2022 to 10/2022
Payer Enrollment Specialist II Curaleaf Santa Rosa, CA,

Responsible for supporting the Centralized Posting Unit (CPU) Team by identifying, initiating, monitoring, and maintaining enrollment requirements set forth by payers, payer intermediaries, and clearinghouses regarding both 837 and 835 forms along with any EFT and payer portal access.

  • Maintained provider enrollments in Medicare and Medicaid across ALL states along with ALL commercial carriers.
  • Confirmed facility and user credentials to initiate and maintain registration and enrollment processes.
  • Addressed credentialing requests, overseeing compliance with governmental and organizational guidelines.
  • Processed documents and status-change requests, conducting followup assessment regarding enrollment inquiries.
  • Handled new enrollments by entering providers' data and reviewing information.
  • Prepared reports on enrollment statistics and discussed how to improve enrollment procedures during team meetings.
12/2011 to 12/2018
  • Strategically steering key account client management within a fast-paced Enrollments Department as the sole contact for high-priority clients regarding insurance carrier protocol / EDI Specialist Mentor for new hires for the EDI Department along with Implementation and Support./ worked closely with the clearinghouse and Insurance carriers to ensure a seamless transition/ processes, credentialing, and patient billing
  • Exhibited sharp analytical abilities toward managing client progress using project plans/schedules to meet goals
  • Continually demonstrated product knowledge of practice management software
  • Recognized multiple times by internal/external clients on delivery of stellar service.
12/2008 to 12/2011
Regional District Manager NAMARA RM, LLC City, STATE,
  • Played a vital role in recruiting, training, mentoring, and managing a top-notch team of 50+ customer service representatives, including actively building and sustaining a dynamic environment of high-quality service and morale-boosting employee performance
  • Cost-effectively handled site-specific revenue and expense management
  • Rapidly advanced to Regional / District Manager role from the initial time of hire
  • Personally handled recruitment, training, and/or disciplinary action for 50+ staff
  • Ensured seamless operational processes by driving efficient troubleshooting and issues resolution
  • Jessica Claire
  • Respected Customer- and Client-Focused Team Builder Committed to Significantly Improving Customer
  • Satisfaction
Education and Training
Expected in 06/2007 to to
High School Diploma:
Brighton High School - Salt Lake City, UT
Expected in to to
Brigham Young University - Idaho - Rexburg, ID
Expected in to to
Utah Valley University - Orem, UT
Additional Information
  • HIPAA Certified
  • Stellar Service-Certified (Customer Service Training)- Received over 40+ awards
  • Microsoft Office ( Word, Excel, Powerpoint, Outlook
  • ZOOM, GoToMeeting
  • NetSuite
  • Change Healthcare- 835/837 Enrollment Form

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Resume Overview

School Attended

  • Brighton High School
  • Brigham Young University - Idaho
  • Utah Valley University

Job Titles Held:

  • Payer Enrollment Specialist II
  • EDI Enrollments Specialist II
  • Regional District Manager


  • High School Diploma
  • Some College (No Degree)
  • Some College (No Degree)

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