Provider Enrollment Specialist Resume Examples

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.

• 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

• 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.

• 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.