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Provider Enrollment Analyst resume examples

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Skills

  • Conflict resolution with payers
  • Inventory management
  • Insurance terminology
  • Business operations
  • RFI Scanners
  • Invoice generation
  • Planning and coordination
  • Effective documentation and record-keeping
  • Organization
  • Insurance plan verification

Work Experiences

  • Management recognized me for providing outstanding customer service.
  • Assessed and processed all forms of supporting documentation, including clinical licenses and insurance credentials, with a 52% success rate.
  • Achieved a 56% decrease in turnaround times.
  • Was in charge of billing activities for medical specialties.
  • Contacted insurance companies to find out more about their policies and payment benefits for patients.
  • Addressed issues between provider enrollment and claims processing software.
  • Assisted in the design and implementation of new policies which decreased rejected applications by 21%.
  • Followed specific security rules and guidelines to protect sensitive data, such as patient medical records and payment card information.
  • Collaborated closely with team members to meet project deadlines, develop solutions, and deliver project requirements.
  • Retained a strong understanding of medical terminology in order to better understand procedures.

Summaries

  • Self-motivated Insurance Verification Specialist with over 8 years of experience learning medical terminology and keeping track of patient coverage.
  • Looking for a company that values dynamic skills and a strong work ethic to take on new challenges with.
  • A composed professional with experience in benefit explanation and administration.
  • Friendly Insurance Verification Specialist with a track record of keeping sensitive patient information private while staying up to date on Medicaid and private policy benefits.
  • Achieved a 25% customer satisfaction score.
  • PMP certified
  • With a team-oriented mentality, highly organized, proactive, and punctual.
  • Expert in initiative with a strong aptitude for improved and implemented.
  • Strategic thinker with expertise in client relations.
  • Proficient in promoting method by leveraging performance reporting and workflow optimization knowledge.

Accomplishments

  • Implemented data validation mechanisms within Power BI that decreased credentialing errors by 83% and improved provider data accuracy.
  • Reviewed provider enrollment policies and worked with legal teams to revise processes in line with evolving payer and CMS requirements.
  • Trained a cross-functional team of 7 staff members to improve both individual and team-level performance on provider enrollment tasks.
  • Trained 3 new hires on the use of Workday for managing provider enrollment, reducing training time, and accelerating team ramp-up.
  • Created a tracking dashboard for provider applications, which improved transparency and accountability and reduced pending applications by 34% in three years.
  • Wrote comprehensive enrollment guidelines for category that streamlined the onboarding process and resulted in faster approval times.
  • Managed escalations for provider enrollment issues with payers and insurers, resolving 79% of cases within one year.
  • Maintained accurate records for 11 healthcare providers, ensuring all data was compliant with national regulations and audit-ready.
  • Ensured 8 providers met payer and network adequacy requirements, securing essential contracts and increasing network flexibility by 32%.
  • Managed ongoing provider re-enrollment projects for procedure, ensuring all documentation met internal and external auditing standards.

Affiliations

  • Mentor, Healthcare Leadership Training Program in Provider Management
  • Fellowship Recipient, National Healthcare Administration Fellowship Program
  • Attendee, Becker's Healthcare Annual Conference on Payer and Provider Management
  • Credentialing Policy Development Committee, Local Chapter of American Medical Association (AMA)
  • Active Participant, National Credentialing Forum
  • Affiliate Member, Medical Group Management Association (MGMA)
  • Volunteer, Healthcare Financial Management Association (HFMA) Credentialing Committee
  • Regular Attendee, The National Provider Enrollment Forum - 2020
  • Volunteer Data Integrity Consultant, Community Health of Atlanta
  • Peer Reviewer, Journal of Healthcare Compliance and Credentialing

Certifications

  • CMS Provider & Supplier Enrollment Basics Certification
  • Certified Professional in Provider Enrollment (CPPE)
  • ServSafe
  • Insurance Payer Contracting and Negotiation Certification (North Carolina)
  • Credentialing and Compliance Certification from the National Association Medical Staff Services (NAMSS)
  • CompTIA Network+
  • Accredited Healthcare Coordinator Professional (AHCP)
  • Credentialing Billing and Coding Compliance Specialist Certification
  • Medical Group Management Association (MGMA) Certification
  • Advanced Certificate in Provider Enrollment Workflow Management

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