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Maeve Guerra
City, State, Zip Code
Home: 000-000-0000 | Cell: 000-000-0000
email@email.com
Professional Summary
Analytical and knowledgeable Provider Enrollment Specialist with extensive knowledge of credentialing and enrollment.Has extensive experience in the healthcare industry. Possesses a Bachelor’s Degree in Business Administration and more than nine years of Provider Enrollment Specialist experience.
Core Qualifications
- Good written and oral communication skills
- Extensive knowledge of conducting eligibility interviews
- Strong analytical skills
- Understanding of insurance regulations and enrollments
- Able to answer questions regarding insurance products
- Strong knowledge of credentialing process for providers
- Above-average computer skills and knowledge of applicable computer applications
Experience
Provider Enrollment Specialist
9/1/2009 – 7/1/2014
Company Name
City, State
- Oversaw processing of and preparation of new member enrollments.
- Completed dis-enrollments as needed.
- Verified and corrected member eligibility issues at least monthly.
- Communicated with members and doctors regarding benefits.
- Utilized state enrollment systems and managed care enrollment systems.
- Conducted all work in accordance with the confidentiality requirements mandated by HIPAA for member information.
- Completed newborn enrollments and notified state of deceased member dis-enrollments.
Provider Enrollment Specialist
5/1/2005 – 8/1/2009
Company Name
City, State
- Verified eligibility for all departments and completed updates of Managed Care System.
- Reported enrollment trends and all problems to management at weekly meetings.
- Completed credentialing applications for providers.
- Monitored all enrollments to identify any processing problems.
- Completed other duties as assigned.
Education
Bachelor’s Degree – Business Administration
2005
University Name
City, State
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