A Provider Enrollment Specialist is hired by the Health care industry to manage and take responsibility for enrolling existing and new physicians. Essential duties commonly seen on the Provider Enrollment Specialist Resume are – overseeing processing and preparation of new member enrolments, completing dis-enrolments, verifying and correcting eligibility issues of members, communicating with Doctors regarding 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.
Those interested in this profession, but depict these qualifications on the resume – a solid knowledge and understanding of health care issues, financial expertise, ability to work under pressure, in-depth knowledge of insurance policies and regulations, excellent knowledge of credentialing processes, and an above-average computing skill. Education in the field of Health or Human services is normally required for this job.
Objective : Dedicated provider enrollment specialist with two years of experience in managing enrollment processes for healthcare providers. Proficient in ensuring compliance with regulations and facilitating seamless onboarding. Committed to enhancing provider relationships and optimizing operational efficiency to support healthcare initiatives.
Skills : Microsoft Office Suite, Proficient In Office Equipment Operation, Knowledge Of Intranet Systems, Provider Enrollment
Description :
Collaborated with healthcare providers to facilitate smooth enrollment and credentialing processes.
Ensured accuracy of provider information to support billing and reimbursement.
Coordinated and tracked credentialing documentation for timely processing.
Acted as the primary liaison between providers and payer companies for credentialing inquiries.
Analyzed credentialing applications for completeness and compliance with standards.
Managed electronic records to maintain confidentiality and accuracy of provider data.
Assisted in special projects related to mergers and acquisitions, ensuring provider integration.
Experience
0-2 Years
Level
Entry Level
Education
B.S. Health Admin.
Junior Provider Enrollment Specialist Resume
Objective : Passionate and detail-oriented Junior Provider Enrollment Specialist with five years of experience in streamlining provider enrollment processes and ensuring regulatory compliance. Skilled in building strong provider relationships and enhancing operational workflows to support healthcare objectives. Eager to contribute to a dynamic team committed to excellence in service delivery.
Skills : Healthcare Provider Enrollment Certification, Strong Organizational Abilities, Effective Communication Skills, Proficient In Microsoft Office Suite, Insurance Verification
Description :
Conduct thorough reviews and assessments of requested clinical privileges for medical staff, ensuring database accuracy.
Act as a liaison between providers, the medical staff office, and related entities to facilitate credentialing and enrollment.
Oversee the credentialing process for new applicants and reappointments, ensuring timely and complete submissions.
Monitor and report on non-compliance issues among providers, maintaining accountability.
Facilitated provider enrollment processes for various healthcare networks and insurance plans.
Manage provider enrollment for the Medicare and Medicaid EHR incentive programs, ensuring compliance with guidelines.
Provide updates to administration and department chairs on changes affecting healthcare payers and billing entities.
Experience
2-5 Years
Level
Junior
Education
BSHA
Provider Enrollment Specialist Resume
Objective : Accomplished Provider Enrollment Specialist with five years of experience in optimizing enrollment processes and ensuring compliance within healthcare systems. Expertise in managing provider relationships and enhancing operational workflows, driving efficiency and accuracy in enrollment operations. Ready to leverage skills to support organizational goals and improve service delivery.
Skills : Provider Relations Management, Training And Development, Interpersonal Skills, Adaptability, Confidentiality, Negotiation Skills
Description :
Managed the end-to-end provider enrollment process, ensuring compliance with regulatory requirements and timely onboarding.
Maintained accurate provider data in the enrollment system, including demographics and credentialing information.
Conducted thorough verification of provider credentials and qualifications for initial and re-credentialing.
Collaborated with healthcare providers to address inquiries and resolve issues related to enrollment and credentialing.
Implemented process improvements that enhanced operational efficiency and reduced administrative errors.
Developed and maintained relationships with payers to facilitate authorization and claims processing.
Performed ongoing data audits to ensure accuracy and prevent duplicate entries in the provider database.
Experience
2-5 Years
Level
Executive
Education
B.S. Health Admin.
Provider Credentialing Specialist Resume
Objective : Results-oriented Provider Credentialing Specialist with five years of extensive experience in managing provider enrollment and ensuring compliance with healthcare regulations. Adept at building strong relationships with providers and streamlining onboarding processes. Committed to enhancing operational efficiency and supporting healthcare initiatives to achieve organizational goals.
Skills : Effective Communication, Patient Registration, Medical Terminology, Attention To Detail, Regulatory Compliance, Claims Processing
Description :
Collaborated with external vendors to manage provider onboarding, ensuring timely delivery of welcome packets and documentation.
Conducted regular follow-ups with insurance payers to address and resolve enrollment discrepancies.
Reviewed specific application requirements for various payers to ensure compliance with regulations.
Fostered strong relationships with credentialing coordinators and payer contacts to facilitate efficient enrollment processes.
Monitored regulatory changes and updated internal processes to maintain compliance.
Utilized data analysis to identify trends and improve provider enrollment efficiency.
Provided guidance and support to new team members on best practices in provider credentialing.
Experience
2-5 Years
Level
Senior
Education
B.S. Health Admin.
Provider Enrollment Specialist Resume
Objective : Detail-oriented Provider Enrollment Specialist with over 5 years of experience in managing provider applications and ensuring compliance with regulatory standards. Proven track record in streamlining enrollment processes, enhancing operational efficiency, and maintaining accurate provider databases. Strong communication skills and adept at collaborating with healthcare professionals to facilitate timely enrollment.
Skills : Hipaa Compliance, Data Management And Organization, Confidential Document Management, Administrative Support Skills, Medicaid Enrollment, Conflict Resolution
Description :
Reviewed provider enrollment packets for missing information and coordinated with providers to obtain necessary documentation.
Resolved discrepancies between submitted information and findings from verification sources such as NPDB and State Dental Boards.
Created and maintained comprehensive provider records in the credentialing database.
Ensured compliance of provider credentials with payer requirements and prepared files for the credentialing committee.
Maintained updated databases tracking medical licenses, DEA certificates, and renewal deadlines.
Verified completion of all required verifications within specified timeframes.
Conducted research on provider status in response to inquiries from internal and external stakeholders.
Experience
0-2 Years
Level
Entry Level
Education
B.S. in HA
Provider Enrollment Coordinator Resume
Objective : Dynamic professional with 5 years in provider enrollment coordination, specializing in regulatory compliance and process optimization. Proven ability to enhance provider relationships and streamline onboarding procedures, contributing to improved operational efficiency. Committed to delivering exceptional service and ensuring accurate and timely provider enrollments within healthcare systems.
Review and verify applications for completeness, following up with providers to obtain missing information.
Develop and maintain spreadsheet databases to track application statuses and progress.
Create and organize files for each provider, ensuring all documents related to enrollment are accurately stored.
Serve as a key resource for resolving provider enrollment issues and inquiries.
Perform administrative duties, including processing incoming mail, handling calls, and managing documentation.
Monitor and update CAQH profiles, ensuring accuracy and compliance with requirements.
Coordinate the collection of required documents, checking licenses, and securing necessary signatures.
Experience
2-5 Years
Level
Consultant
Education
B.S. Health Admin.
Provider Enrollment Specialist Resume
Objective : Experienced Provider Enrollment Specialist skilled in navigating complex enrollment processes and ensuring adherence to state and federal regulations. Proficient in data management and analysis, with a focus on improving provider onboarding timelines. Excellent interpersonal skills, enabling effective collaboration with healthcare teams and stakeholders to optimize enrollment workflows.
Skills : Research Skills, Epic Systems Proficiency, Billing Knowledge, Quality Assurance, Process Improvement, Policy Interpretation
Description :
Executed administrative and technical duties with precision in the provider enrollment department.
Oversaw all components of the payor enrollment process for healthcare providers.
Monitored evolving insurance enrollment regulations to ensure compliance.
Reviewed and verified provider licenses and certifications to maintain compliance standards.
Coordinated managed care enrollment activities, ensuring provider participation.
Engaged with external agencies to facilitate enrollment processes.
Prepared and submitted enrollment applications for physicians to managed care entities.
Experience
0-2 Years
Level
Entry Level
Education
B.S. in HA
Assistant Provider Enrollment Specialist
Resume
Headline : Accomplished Assistant Provider Enrollment Specialist with 7 years of experience in managing complex provider enrollment processes and ensuring compliance with healthcare regulations. Proven ability to enhance provider relationships and streamline onboarding procedures, contributing to operational efficiency and improved service delivery in healthcare settings.
Communicated with insurance companies to resolve enrollment issues and discrepancies.
Collaborate closely with providers and hospital staff to ensure timely return of required enrollment documents.
Developed and maintained provider databases to track enrollment status and updates.
Add providers and enter provider numbers into AthenaNet, marking them as PAR for claims processing.
Assisted in training new staff on provider enrollment procedures and best practices.
Conduct re-credentialing of providers as required by payers.
Coordinate with the contracting department to ensure timely enrollment for providers under new contracts.
Experience
5-7 Years
Level
Executive
Education
B.S. Health Admin
Provider Enrollment Specialist Resume
Objective : With five years of comprehensive experience in provider enrollment, I specialize in streamlining onboarding processes and ensuring compliance with healthcare regulations. My expertise lies in fostering strong provider relationships and optimizing operational workflows, significantly enhancing service delivery within healthcare systems. I am poised to contribute effectively to a forward-thinking team.
Skills : Data Management, Claims Management, Healthcare Claims Processing, Provider Communication, Problem Solving, Credentialing
Description :
Reviewed and approved provider out-of-state Medicaid applications, ensuring adherence to business rules and licensure requirements.
Ensured healthcare providers complied with all federal and state regulations, enhancing operational integrity.
Executed data entry functions in the Medicaid Management Information System (MMIS) for accurate provider enrollments.
Updated provider information to maintain current accounts, ensuring data accuracy.
Managed incoming and outgoing mail from multiple providers, facilitating efficient communication.
Responded to provider inquiries regarding enrollment status, ensuring timely and accurate information dissemination.
Conducted follow-up calls and maintained up-to-date data in credentialing databases, ensuring timely renewals of licenses and certifications.
Experience
2-5 Years
Level
Executive
Education
B.S. Health Admin.
Senior Provider Enrollment Specialist Resume
Headline : Results-focused Senior Provider Enrollment Specialist with over 7 years of experience in overseeing provider enrollment processes and ensuring compliance with healthcare regulations. Adept at optimizing workflows, enhancing provider relationships, and driving operational efficiency. Eager to leverage extensive expertise to support organizational goals and deliver exceptional enrollment services.
Oversee the completion and submission of provider enrollment applications, ensuring accuracy and compliance.
Track and follow up on provider numbers, ensuring timely establishment and linkage to appropriate group entities.
Interpret application requirements and regulations, providing guidance to applicants.
Maintain comprehensive documentation and reporting on provider enrollments in process.
Collaborate with program site management and corporate resources to expedite completion of enrollment requirements.
Manage provider enrollment data within the credentialing database, ensuring data accuracy.
Facilitate interdepartmental communication to achieve enrollment objectives.
Experience
5-7 Years
Level
Senior
Education
BSHA
Provider Enrollment Specialist Resume
Objective : As a Provider Enrollment Specialist with two years of experience, I excel in managing the enrollment process and ensuring compliance with healthcare regulations. My focus on fostering provider relationships and streamlining onboarding procedures has significantly improved operational efficiency. I am dedicated to supporting healthcare initiatives and enhancing service delivery.
Skills : Data Entry, Powerpoint, Bilingual Communication, Time Management, Team Collaboration, Analytical Skills
Description :
Managed the timely enrollment of new providers with various third-party payors and maintained active physician data.
Oversaw and updated provider information in the CAQH system, ensuring accuracy and compliance.
Processed termination requests to health plans promptly to maintain compliance.
Coordinated the enrollment of new providers with governmental payors, including Medicaid.
Maintained ongoing updates of provider data, including demographic and billing information.
Ensured timely submission of provider applications to meet enrollment deadlines.
Distributed essential information to departmental representatives, credentialing teams, and administrators.
Experience
0-2 Years
Level
Entry Level
Education
BSHA
Junior Provider Enrollment Specialist Resume
Objective : Motivated Junior Provider Enrollment Specialist with five years of experience in facilitating provider enrollments and ensuring adherence to healthcare regulations. Expertise in managing provider documents and enhancing communication between stakeholders. Dedicated to improving enrollment processes and building strong provider relationships to support organizational success.
Skills : Provider Enrollment Management, Software Proficiency, Data Analysis, Electronic Health Records, Billing Procedures, Audit Preparation
Description :
Prepared and submitted provider enrollment applications for Medicaid and Medicare, ensuring accuracy and compliance.
Managed the credentialing and re-credentialing processes for both new and existing providers.
Acted as the primary liaison between healthcare providers, administrative staff, and payers to facilitate effective communication.
Guided new providers through application processes, ensuring all required documents were collected and submitted.
Resolved inquiries related to provider enrollment, updates, and credentialing efficiently and effectively.
Conducted periodic reviews of provider licenses and malpractice coverage to maintain compliance.
Utilized Epic to update accounts and address claim denials, improving processing times.
Experience
2-5 Years
Level
Junior
Education
B.S. Health Admin.
Provider Enrollment Specialist Resume
Summary : Accomplished Provider Enrollment Specialist with 10 years of expertise in managing complex enrollment processes and ensuring strict compliance with healthcare regulations. Proficient in enhancing provider relationships and driving operational efficiency through effective onboarding strategies. Committed to supporting healthcare initiatives and improving service delivery across diverse healthcare systems.
Skills : Healthcare Compliance Software, Data Entry And Management, Regulatory Documentation Review, Record Keeping, Database Management, Multi-tasking
Description :
Analyzed documentation from healthcare providers to ensure compliance with federal, state, and local regulations.
Verified providers' demographic and programmatic information using advanced data analysis techniques.
Drafted and disseminated correspondence to the provider community in line with Medicaid policies.
Maintained accurate records in the MMIS system, ensuring data integrity.
Monitored credentialing and re-credentialing applications using advanced Microsoft Excel techniques.
Applied knowledge of program operations and regulations to enhance compliance measures.
Summary : With a decade of specialized experience in provider enrollment, I excel in optimizing processes and ensuring compliance with healthcare regulations. My expertise includes enhancing provider relationships and streamlining onboarding, significantly improving operational efficiency. I am committed to delivering exceptional service and driving enrollment success within healthcare organizations.
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