Provider Enrolment Specialist CV Sample

Analytical and knowledgeable Provider Enrolment Specialist with extensive knowledge of credentialling and enrolment.Has extensive experience in the healthcare industry. Possesses a Bachelor’s Degree in Business Administration and more than nine years of Provider Enrolment Specialist experience.

• Good written and oral communication skills
• Extensive knowledge of conducting eligibility interviews
• Strong analytical skills
• Understanding of insurance regulations and enrolments
• Able to answer questions regarding insurance products
• Strong knowledge of credentialling process for providers
• Above-average computer skills and knowledge of applicable computer applications

September 2009 to July 2014 Health Systems, Inc.—London, UK Provider Enrolment Specialist

• Oversaw processing of and preparation of new member enrolments.
• Completed dis-enrolments as needed.
• Verified and corrected member eligibility issues at least monthly.
• Communicated with members and doctors regarding benefits.
• Utilised state enrolment systems and managed care enrolment systems.
• Conducted all work in accordance with the confidentiality requirements mandated by HIPAA for member information.
• Completed newborn enrolments and notified state of deceased member dis-enrolments.

May 2005 to August 2009 United Healthcare, Inc.—London, UK Provider Enrolment Specialist

• Verified eligibility for all departments and completed updates of Managed Care System.
• Reported enrolment trends and all problems to management at weekly meetings.
• Completed credentialling applications for providers.
• Monitored all enrolments to identify any processing problems.
• Completed other duties as assigned.