Proficient Provider Enrollment Specialist promoting a 8-year career managing physician credentialing data. Dedicated individual with financial eligibility process understanding. Seeking a new position with an established company that offers help to those that need it and values their employees.
Skills
Healthcare knowledge
Health Insurance knowledge
Effective written and verbal communication
Special projects
Reporting and file reviews
Physician enrollment
Program understanding and advisement
Customer service
Relationship building
Planning
Leadership
Experience
02/2013 to Current
Provider Enrollment SpecialistAmita Health – Woodbury, TN,
Accurately inputted provider effective dates into enrollment system using PowerStep Claims payment system.
Utilized effective active listening, interpersonal and communication skills in collaborating with different individuals on a daily basis.
Responded to requests for information about specific practitioners enrollment process and attached them to the correct fee schedule based upon their specialty or practice location.
Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
Responsible for updating all info that pertains to the practitioners in our system.
Work closely with Claims Examiners on determining why a certain claim stopped or why something didn't get paid correctly. Trouble-shooting.
Work closely with the System Configurations team to identify any issues causing problems or delays to the way a claim pays or doesn't pay.
Responsible for being familiar and having knowledge of all counter parts of the health plan including members, member groups and what they can an can't access, back-end system processing, mailroom, contracting and rules and regulations around our Medical Supplement product
work closely with our credentialing counterpart to assure providers are being successfully credentialed or not - taking system actions dependent upon these credentialing pieces such as terming a provider that no longer meets the criteria.
01/2012 to 02/2013
Front Desk Administrative AssistantThe Lake Doctors, Inc. – Jacksonville, FL,
Maintained general office organization and cleanliness.
Responded to messages and emails to the office and transferred correspondence.
Transmitted information or documents to customers, using computer, mail or facsimile machine.
Produced and distributed memos, newsletters, email updates and other forms of communication.
Educated clients, patients and customers on our independent radiology group and what that means through oral communication and self-created handouts.
Performed administrative support tasks, completing duties within required timeframes.
Handled management of communication to executives by taking and making telephone calls, reviewing and prioritizing mail and composing and typing correspondence.
Kept office equipment functional and supplies well-stocked to promote efficient operations.
Pleasantly welcomed visitors, answered phone calls and maintained front reception desk.
Organized files, developed spreadsheets, faxed reports and scanned documents, maintaining front desk and reception area in neat and organized fashion.
Handled incoming calls and directed callers to appropriate department or employee.
06/2008 to 01/2012
Sales Associate and Assistant BuyerGreat Western Bank – Fort Collins, CO,
Responded promptly to customer inquiries, needs and problems.
Rang up customers at cash register to process sales transactions.
Balanced needs of multiple clients simultaneously in fast-paced retail environment.
Completed ongoing quality checks on baby care products, closely following strict quality assurance guidelines.
Completed Buyer training courses in order to successfully choose the best brands with the best quality when purchasing for the store.
Helped with inventory and displays
07/1999 to 04/2008
Credit AnalystCitibank – City, STATE,
Reviewed customer financial data to ascertain level of risk involved for extending credit.
Requested financial documents from customers.
Developed comprehensive understanding of financial statements, enhancing opportunities to assess risk.
Assessed customer credit files regularly to review receivables.
Monitored and maintained compliance with internal controls and government regulations.
Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
Prioritized and organized tasks to efficiently accomplish service goals.
Demonstrated self-reliance by meeting and exceeding workflow needs.
Provided excellent service and attention to customers when face-to-face or through phone conversations.
Education and Training
Expected in to to
: Computer And Information Sciences Colorado Technical University - Sioux Falls, SD, GPA:
Expected in to to
: Criminal Justice Iowa Lakes Community College - Estherville, IA GPA:
Expected in 05/1997 to to
High School Diploma: Parker High School - Parker, SD GPA:
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