Provider Enrollment Specialist Resume Example: 4 Templates

Provider Enrolment Specialists supervise the enrollment of new and current physicians in the healthcare business. Assessing potential participants, keeping written evaluations, participating in team meetings, and aiding with financial eligibility processes are all essential activities featured on a Provider Enrollment Specialist resume example.

The ideal candidate’s CV should include the following qualifications: awareness of healthcare concerns, organizational abilities, financial experience, computer competencies, and the ability to operate under pressure. Education in health and human services is essential, with a specialization in customer service or social work.

Resume Template: 1

Provider Enrollment Specialist Resume

Richard D. Harding

Laguna Beach, Los Angeles 

(123) 4567890

[email protected]


Summary

Specialist in Provider Enrollment who is analytical and well-versed in enrollment and credentialing. Has a wealth of expertise in the medical field. Possesses a business administration bachelor’s degree and more than nine years of experience as a provider enrollment specialist.


Experience

Company A, Provider Enrollment Specialist 

  • Supervised the preparation and processing of new member enrollments.
  • Disenrollments were finished when needed.
  • Verified and fixed concerns with member eligibility at least once every month.
  • Consulted members and physicians about benefits.

Company B, Provider Enrollment Specialist

  • Verified eligibility for all departments and updated the Managed Care System.
  • During weekly meetings, I reported enrollment trends and any problems to management.
  • Provider credentialing applications were completed.
  • All enrollments were monitored for any processing issues.
  • Other tasks were completed as assigned.

Company C, Provider Enrollment Specialist

  • Utilized the managed care and state enrollment platforms.
  • Conducted all work in compliance with HIPAA’s member information confidentiality rules.
  • Finished newborn enrollments and informed the state of dead member dis-enrollments.

Education

Florida State University

Masters in Computer science 


Certifications

  • Certified Public Provider Enrollment Specialist
  • Certified company Provider Enrollment Specialist

Skills

  • Data credentialing and coordination
  • Enrollment of practitioners
  • [Software] Knowledgeable
  • Evaluations of potential participants
  • Procedures for determining financial eligibility
  • Disagreements are validated.
  • Communication abilities that are effective
  • Program understanding
  • Knowledge of [Software]
  • Paperwork and documentation

Resume Template: 2

Provider Enrollment Specialist Resume

Richard D. Harding

Laguna Beach, Los Angeles 

(123) 4567890

[email protected]


Summary

Enrollment Specialist for Providers Overseeing the processing and preparation of new member enrolments, completing dis-enrolments, verifying and correcting member eligibility issues, communicating with Doctors about benefits, assessing potential participants, assisting in the financial eligibility processing work, maintaining written assessments, monitoring all enrolments, identifying processing errors, and completing all duties as assigned are on the resume.


Experience

Company A, Provider Enrollment Specialist 

  • Enrollment request submissions to my allocated states’ commercial payers were processed.
  • Managed the work log for Application Specialists when they started the enrollment process.
  • Follow-up calls were made to Payers for Enrollment to ensure approval status.
  • W-9 forms were created for the contracted HCA organizations.
  • CAQH Maintenance for assigned HCA Contracted Providers was completed.
  • Helped with Special Projects

Company B, Provider Enrollment Specialist

  • Established ties with provider offices to guarantee correct documentation processing.
  • Follow-up with Office Staff to ensure timely and correct application handling/processing
  • Trained and supervised new employees to ensure quality and professionalism.

Company C, Provider Enrollment Specialist

  • Analyzes physician enrollment, re-enrollment, and dis-enrollment data to determine timely completion in line with contract terms.
  • Examines all system-generated report errors for global issues that can be resolved through process optimization.
  • Maintains and develops partnerships with outside providers and Managed Care Health Plans.
  • Within a [number of months] month period, I developed and implemented unique team-building tactics that increased communication, leadership, and diversity awareness in clinical settings.

Education

Florida State University

Masters in Computer science 


Certifications

  • Certified Public Provider Enrollment Specialist
  • Certified company Provider Enrollment Specialist

Skills

  • Proficient in data analysis and relational database skills, with shown ability in report building utilizing complicated queries.
  • Excellent organizational skills, attention to detail, ability to prioritize and multitask, and ability to fulfill deadlines
  • The ability to maintain a professional demeanor

Resume Template: 3

Provider Enrollment Specialist Resume

Richard D. Harding

Laguna Beach, Los Angeles 

(123) 4567890

[email protected]


Summary

Works on all aspects of provider enrollment, re-enrollment, and expiable management, assuring fast and accurate provider enrolment (and credentialing) in commercial and government payers. Making phone calls to payers, asking for network involvement, and following up on received applications.


Experience

Company A, Provider Enrollment Specialist 

  • Performs assigned responsibilities in the Provider Enrollment Unit.
  • Develop and develop connections with Network Representatives to help with provider enrollment/re-enrollment.
  • Using an automated enrollment procedure, make decisions on provider enrollment applications based on Virginia Medicaid program requirements.

Company B, Provider Enrollment Specialist

  • Manage and manage Medicaid, Medicaid HMO, and Private Insurance provider lists.
  • All relevant provider number entries are kept in the TeamWorks database.
  • Assists in the review of Business Services report choices, and results in reference to specified goals.
  • Contact physicians and non-physician providers to confirm and rectify any information on the paperwork that has been rejected by insurance companies.

Company C, Provider Enrollment Specialist

  • Provides management with regular reports on the progress of each provider’s approval and claim resolution.
  • Completes and gets all required documents, including malpractice applications, signatures on payer applications, and updates for all providers.
  • Collaborates with Athena to find missing or incorrect billing information.

Education

Florida State University

Masters in Computer science 


Certifications

  • Certified Public Provider Enrollment Specialist
  • Certified company Provider Enrollment Specialist

Skills

  • Have good verbal and written communication abilities, as well as professional phone skills.
  • Exhibits great communication skills as well as the ability to prioritize tasks based on organizational and financial goals/impact.
  • Ability to organize, analyze, observe, make judgments, and fulfill deadlines with attention to detail
  • Ability to swiftly learn new software applications
  • Excellent detail-oriented skills, excellent writing and verbal communication abilities, including professional telephone skills
  • Ability to access and retrieve information from a computer and basic knowledge of Microsoft Office products

Resume Template: 4

Provider Enrollment Specialist Resume

Richard D. Harding

Laguna Beach, Los Angeles 

(123) 4567890

[email protected]


Summary

The Provider Enrollment Specialist guides a new provider’s application through all stages of enrollment with commercial and/or government payers, as well as facilities. The Specialist is also in charge of updating practitioner information in both internal software and with third-party payers.


Experience

Company A, Provider Enrollment Specialist 

  • Ensures that all providers’ hospital privileges are renewed and their payer credentials are updated.
  • Quantity – Meets performance and/or productivity requirements
  • Attendance/Punctuality – Is constantly on time and at work.
  • Professionalism is approaching people with tact; treating others with respect and concern regardless of status or position. Maintains successful business partnerships

Company B, Provider Enrollment Specialist

  • Data input of provider information into the Medicaid Provider System from provider enrollment forms and any supporting materials
  • Collaborates with the Provider Enrollment Specialist to handle difficult provider hold concerns.
  • Interacting with providers via phone and written contact to answer questions or acquire further information about a provider’s enrollment.
  • Prepares the paperwork required for the issue of provider numbers to physicians and physician assistants affiliated with the billing service.
  • Maintaining and updating provider records in accordance with NYS standards and procedures Acts as a liaison to providers enrolling in the Medicaid program
  • Meets accuracy, timeliness, and confidentiality performance standards

Company C, Provider Enrollment Specialist

  • Verified eligibility for all departments.
  • Complete updates of the managed care system.
  • Monitored all enrollments to identify and diagnose the problems.
  • Always completed the work given by the seniors at proper deadlines.

Education

Florida State University

Masters in Computer science 


Certifications

  • Certified Public Provider Enrollment Specialist
  • Certified company Provider Enrollment Specialist

Skills

  • Excellent clerical abilities.
  • Microsoft Office proficiency. Knowledge of credentialing software is advantageous but not necessary.
  • Ability to communicate successfully with a wide range of people (physicians and medical staff offices).
  • Our clients receive the best customer service possible.
  • Excellent written and oral communication abilities.
  • Excellent presentation and client engagement abilities.

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