Provider Enrollment Specialist Resume Guide

Skilled provider enrollment specialist with 5+ years of experience in healthcare administration and provider registration. Experienced in handling all aspects of the Medicaid/Medicare credentialing process, including verification and enrollment applications. At XYZ Company, successfully onboarded over 500 providers within a two-month period to increase efficiency by 20%. Proven ability to ensure accuracy while completing complex tasks in high-pressure situations.

Professional provider enrollment specialist with 10+ years of experience in the health care industry. Skilled at verifying provider credentials and ensuring compliance with payer regulations for Medicare, Medicaid, BCBS, Aetna and UnitedHealthcare plans. At XYZ Medical Center increased accuracy of submitted enrollment data from 80% to 95%. Adept at negotiating rates between providers and insurance companies while maintaining excellent customer service standards.

Proficient provider enrollment specialist with 7+ years of experience in a fast-paced healthcare setting. Proven track record of processing applications, verifying credentials and reviewing documents to ensure compliance with government regulations. Achieved 99% accuracy rate on all provider enrollments at XYZ Company while meeting deadlines consistently. Seeking to leverage my expertise as an Enrollment Specialist for ABC Healthcare Group.

Committed provider enrollment specialist with 8+ years of experience in the healthcare industry. Proven track record of streamlining processes to reduce costs, improve accuracy and maintain HIPAA compliance. Skilled at verifying medical license credentials, researching provider information for insurance contracts, and preparing detailed reports for management review. Seeking to join ABC Company as a Provider Enrollment Specialist.

Enthusiastic provider enrollment specialist with 4+ years of experience streamlining the workflow process to ensure timely and accurate provider data entry. Adept in analyzing billing information, verifying accuracy of claims submissions, and resolving discrepancies. Seeking to join ABC Solutions as a Provider Enrollment Specialist where my problem-solving skills can help optimize operations for optimal customer satisfaction.

Energetic provider enrollment specialist with 5+ years of experience in the healthcare industry. Demonstrated excellence in evaluating and processing provider applications, including verifying credentials and validating demographic information. At ABC Company, successfully managed up to 10 concurrent projects while meeting all deadlines. Skilled at using multiple software systems for data entry and reporting purposes.

Determined provider enrollment specialist with 8+ years of experience in the healthcare industry. Adept at providing comprehensive and accurate provider enrollment services to ensure compliance with all applicable regulations, laws, and requirements. At XYZ Medical Center, managed a successful project that streamlined the process for enrolling new providers into Medicare/Medicaid programs by 25%.

Talented provider enrollment specialist with 5+ years of experience in healthcare office settings. Highly skilled in all aspects of the provider onboarding process, from verifying paperwork to coordinating credentialing services and proactively addressing potential issues. Proven ability to build relationships with providers and maintain compliance standards at ABC Medical Group.

• Utilized software such as Provider Express and Medicare Advantage to enroll over 350+ providers into the appropriate plans, ensuring all relevant documentation was accurate.
• Presented enrollment information at workshops with up to 50 attendees while encouraging providers to join a variety of plans; successfully enrolled 75% more participants than expected in last quarter alone.
• Represented assigned plan and network requirements during negotiations between doctors, hospitals and other health care facility representatives; led successful outcomes in 80% of meetings attended.
• Audited provider contracts for accuracy against established guidelines before approval by Management team; reduced errors by 15%.
• Reliably maintained database records of approved applications, pre-enrollment verifications & monthly recertification activities with 100% accuracy rate according to company standards.

• Meticulously evaluated and verified all provider enrollment applications, ensuring accuracy of information and compliance with government regulations; reduced the number of rejected submissions by 30%.
• Advised over 300 providers on proper documentation needed for successful application submission; increased acceptance rate by 25% in 1 year.
• Achieved 100% customer satisfaction rating from healthcare professionals on a weekly basis due to prompt response time (under 4 hours) and knowledge of Medicare/Medicaid rules & guidelines.
• Introduced an automated system that streamlined the process of verifying provider credentials, resulting in fewer errors, improved efficiency and saved at least 10 hours per week in administrative costs.
• Successfully enrolled more than 500 new providers within 6 months while maintaining quality control standards set forth by the organization’s accreditation board.

• Proficiently reviewed and enrolled 350+ providers onto various insurance plans, ensuring accurate completion of applications in accordance with state and federal guidelines.
• Optimized provider enrollment process by creating automated workflows to track application progress from submission to approval; reduced processing time by 25%.
• Scheduled weekly meetings with the department team members to discuss strategies for improving enrollment processes, resulting in a 20% increase in overall efficiency.
• Formulated new policies & procedures designed specifically for provider onboarding which improved accuracy of data entry on submitted applications by 45%.
• Improved response times when addressing inquiries related to enrollments or updates made within the system; responded within 6 hours on average as opposed to 12 before implementation of these changes.

• Diligently processed and verified healthcare provider applications, resulting in a successful enrollment of 600+ providers with insurance companies within 3 months.
• Documented all data related to provider enrollments into the CRM system; established a comprehensive database that enabled quick retrieval of critical information when needed.
• Expedited approval processes by providing thorough reviews and timely responses to customer inquiries; helped reduce processing times from 4 weeks to 2 weeks on average per application.
• Participated in regular meetings with cross-functional teams, such as IT staff and project managers, to ensure updates were made accurately for all enrolled providers’ accounts across multiple systems/platforms.
• Facilitated communication between customers and internal stakeholders regarding enrollment status changes or discrepancies; resolved issues quickly so that no further delays occurred in the process overall.

• Reorganized provider enrollment processes, resulting in an 8% increase in efficiency and a $2,000 cost savings.
• Spearheaded the acquisition of new providers for coverage expansion; successfully enrolled over 100 medical practices with minimal errors or delays.
• Tracked provider applications from start to finish utilizing advanced database software; updated status reports regularly to ensure compliance with deadlines and regulations.
• Coordinated enrollment activities between healthcare facilities and insurance companies to verify eligibility requirements were met before processing applications for approval/denial decisions quickly and accurately.
• Efficiently managed data entry jobs related to credentialing documents such as licenses, certifications & malpractice forms with accuracy rates of 98%.

• Submitted over 100 provider enrollment applications on behalf of clients and successfully secured 92% acceptance rate within the designated timeframe.
• Compiled and maintained accurate records for all enrollments, including paperwork tracking, status updates and payment information; reduced errors by 75%.
• Resourcefully identified potential discrepancies between medical claims data from insurance payers and provided timely resolutions to prevent any delays in payments or denials.
• Reconciled over $1 million worth of unpaid claims with insurance companies utilizing various methods such as appeals filing, administrative review process etc., resulting in an increase of recovery rate by 10%.
• Prepared detailed reports regarding enrollment activities that enabled managers to accurately track progress against organizational goals; increased efficiency by 30%.

• Revised and updated provider enrollment forms for over 200+ healthcare providers, leading to a 72% improvement in accuracy and compliance.
• Streamlined the review process by implementing new processes that reduced turnaround time from 2 days to 1 day per application.
• Confidently managed the maintenance of existing records within an electronic database system; enabled speedy retrieval of data when needed and improved customer service delivery by 48%.
• Demonstrated excellent problem-solving skills when addressing issues related to provider contract eligibility requirements, resulting in increased revenue collection rate by 30%.
• Demonstrated strong organizational abilities while managing up to 300 daily requests for information on various matters such as payment rates, credentialing status updates, reimbursement policies etc.; successfully responded within 24 hours or less on 95% occasions.

Bachelor of Science in Health Administration
Educational Institution XYZ
Nov 2011

Certified Provider Enrollment Specialist (CPES)
American Medical Bill
May 2017