provider enrollment supervisor resume example with 17+ years of experience

Jessica Claire
Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
Home: (555) 432-1000 - Cell: - - : - -
Background, Objective

12+ years of extensive experience working in the health insurance sector and adept at guidelines, procedures, and health insurance regulations. My objective is to extend my knowledge in Medicaid, by gaining experience in the Florida Kidcare Title XXI Children's Health Insurance Program.

Skill Highlights
  • Inventory management
  • Work flow management
  • Prepare and present required training
  • Complete time or attendance forms
  • Establish employee performance standards
  • HIPAA trained
  • Analyze operational and management reports/records
  • Investigate and resolve client or public complaints
  • Comprehensive knowledge of insurance regulations, processes, and guidelines
  • Extensive knowledge of application processing, verifying eligibility, procedures, and guidelines
  • Possess sound oral and written communication skills
  • Skilled in handling multiple task and hast he ability to work under pressure
Professional Experience
08/2014 to 06/2015
Provider Enrollment Supervisor Envision Healthcare Glendale, AZ,
  • Develop policies, procedures, methods, or standards for daily operations.
  • Prepare and maintain employee records.
  • Examine documents for completeness, accuracy, or conformance to standards.
  • Confer with other departmental heads to coordinate company/department activities.
  • Maintain inventory of office equipment and supplies.
  • Resolve personnel problems or grievances.
  • Schedule employee work hours.
  • Prepare Corrective Action Plans when the department doesn't meet the Service Level Agreement listed in the FPR.
  • Meet with the Client on a weekly basis to discuss any processing concerns and upcoming changes that will affect the Provider Enrollment department or company as a whole.
  • Assist with designing and implementing new changes made to the FLMMIS system.
11/2010 to 08/2014
Provider Enrollment Unit Lead University Of California San Mateo, CA,
  • Process Medicaid Fiscal Administration Operations requests upon receipt.
  • Run production reports and distribute work to processors daily.
  • Prepare weekly report for delivery to the client.
  • Prepare and deliver employee monthly evaluations.
  • Prepare and deliver monthly training for Provider Enrollment and Call Center.
  • Research any escalated issues from providers and client.
  • Manage work flow.
07/2010 to 12/2010
Provider Enrollment Processing Specialist Verra Mobility Corporation Ma, MA,
  • Process FL Medicaid provider applications.
  • Process file maintenance.
  • Process fingerprint cards and submit provider payments to Banking on a weekly basis.
01/2010 to 05/2010
Lab Manager Ascena Retail Group Palm Desert, CA,
  • Run experiments for students and professors.
  • Test experiments to make sure there are no problems before running Maintain labs cleanliness.
  • Answer any questions subjects may have during experiments.
  • Report any problems with equipment to IT for repair.
  • Research and resolve discrepancies from students and professors and communicate results to appropriate party on an as needed basis.
09/2007 to 10/2009
Senior Processing Specialist Abbvie, Inc Fort Smith, AR,
  • Assists the Management Team as lead processor, with coordination and scheduling of work flow, and training for Enrollment Processing staff.
  • Assists Management Team with setup and testing of data entry programs for enrollment and re-enrollment.
  • Assists Management Team in coordinating activities with Implementation, Enrollment and Communication Teams during seasonal client enrollment.
  • Data enter/Dual data enter of customer data and benefits.
  • Researches and resolves discrepancies between customer data and benefits and communicate results to appropriate parties on an as needed basis.
03/2007 to 10/2007
Assistant Manager Olin Corporation Houston, TX,
  • Supervised employees, making sure that their job was completed.
  • Made sure deposits were completed and ready for drop off at the bank.
  • Performed closing duties (i.e.
  • cleaning the store, putting back returns, and counting down the registers).
  • Maintained the safe.
09/2003 to 05/2007
Training Coordinator Borgwarner Inc. Kokomo Technical Center, IN,
  • Screened applicants for employment thru tests and background checks and refers qualified applicant to hiring authorities.
  • Validated payroll.
  • Conducted exit interviews with terminating employees.
  • Provided information and counseling to managers and employees concerning the application and interpretation of personnel policies and procedures.
  • Maintained record of employment activity and compiles statistical and analytical reports to meet applicable laws/regulations and Company requirements.
  • Worked in Invoicing, Accounting, and Receiving as backup.
10/2001 to 08/2003
  • Processed child support payments for the State of Florida.
  • Researched discrepancies once all work has been processed for the day.
04/2001 to 09/2001
Customer Service Representative WILLIAMS TRAVEL CENTER City, STATE,
  • Assisted customers with purchases Assisted truck drivers with diesel receipts and assigning available showers.
  • Stocked shelves and coolers Dust and mop whenever needed.
  • Maintained cash drawer with minimal to no shortages.
05/1997 to 04/2001
Office Personnel IGA City, STATE,
  • Maintained safe Counted all cash drawers at the end of each cashiers shift to ensure drawer was correct.
  • Researched any discrepancies.
  • Prepared deposits for the bank.
  • Cashed checks Processed Western Union Processed lottery requests Provided change to cashiers when needed.
Education and Training
Expected in 10/2001 05/2000 to to
University of Phoenix - Phoenix, AZ

Extensive knowledge of Florida Medicaid Management Information System (FMMIS)

Experienced in analyzing all incoming provider data for eligibility and managed care enrollment and the related systems, which interface with FMMIS (i.e. DOH, HQA, etc.)

Knowledgeable of Oracle databases

Highly capable of producing reports of research findings, preparing recommendations, coordinating and implementing system changes and performing any other functions related to the integrity of provider eligibility on FMMIS

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Resume Overview

School Attended

  • University of Phoenix

Job Titles Held:

  • Provider Enrollment Supervisor
  • Provider Enrollment Unit Lead
  • Provider Enrollment Processing Specialist
  • Lab Manager
  • Senior Processing Specialist
  • Assistant Manager
  • Training Coordinator
  • Data Entry Specialists
  • Customer Service Representative
  • Office Personnel



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