Enrollment Specialist Provider
Resume:
Janel Andrews
Provider Enrollment Specialist
**************@*****.***
Seeking a challenging position in a
growth oriented environment that will
enable me to contribute to the success
of the company while simultaneously
providing me with an opportunity to
grow and thrive professionally.
.
UNIV. OF PHOENIX
BACHELOR'S OF SCIENCES
HEALTHCARE ADMIN/ MANAGEMENT
09/22 - 11/25
HERZING UNIVERSITY
Associates-Business
Administration
1988 – 1990
SOFT SKILLS
Able to Listen
Accept Feedback
Adaptable
COMPUTER
Microsoft Word
Microsoft Excel
Microsoft Outlook
Microsoft PowerPoint
Analytics
PERSONAL SKILLS
Creative thinking
Developing Rapport
Diplomacy
Leadership
Service
JACKSON HOSPITAL
REVENUE CYCLE SPECIALIST
MARCH 2024 TO SEPTEMBER 2024
BILLING PATIENTS AND THRID PARTIES FOR ADMINISTERED CARE, HANDLING INCOMING PAYMENTS, CALCULATING PATIENT INTAKE COST, TRACKING ACCOUNTS RECEIVABLE TO ENSURE ACCURACY. ALSO WORK WITH PATIENTS TO ARRANGE SPECIAL PAYMENT OPTIONS WHEN NECESSARY.ALSO WORK WITH PATIENTS TO ARRANGE SPECIAL PAYMENT OPTIONS WHEN NECESSARY. PROVIDER ENROLLMENT ANALYST
PALMETTO GBA( BLUECROSS BLUE SHIELD MEDICARE) - SOUTH CAROLINA (WAH) ( CONTRACT)
NOV 2020 TO AUGUST2023
PROCESSING NEW AND ESTABLISHED MEDICARE PART B PROVIDER APPLICATIONS, AND ENSURING THAT ALL PROVIDERS GIVEN A NUMBER ARE IN COMPLIANCE WITH THE CMS REGULATIONS. ASSIGN AND LOG ALL MEDICARE PROVIDER NUMBERS IN AN ACCURATE AND TIMELY MANNER. APPROVED, DENIED, OR REJECTED APPLICATIONS BASED ON THE CMS GUIDELINES. MAINTAINS PECOS DATABASES FOR ALL PRACTITIONERS. ENSURE THAT ALL INFORMATION MEETS FEDERAL AND STATE GUIDELINES WHEN PROCESSING APPLICATIONS. ENFORCE REGULATORY COMPLIANCE AND QUALITY ASSURANCE. DETERMINE THE PROPER CREDENTIALS NEEDED FOR EACH TYPE OF PROVIDER. SECURE ALL INFORMATION AND VERIFY LICENSE WITH PROPER STATE AGENCY IF APPLICABLE. COMPLIED WITH CMS AND HIPAA GUIDELINES AND REGULATIONS. ANSWERED CONTACT CENTER CALLS. VERIFIED ENROLLMENT STATUS FOR PROVIDERS. REVALIDATION PROJECT Credentialing Coordinator-(Atlanta Perinatal Associates)(Contract) KLS Workforce Solutions- Atlanta, GA - July 2016 to November 2016 Responsible for organizing, maintaining, and verifying all aspects of the credentialing process for healthcare practitioners in a health care-related facility. In all activities, they must comply with all legal and regulatory policies and procedures. Provider Enrollment Specialist- (Cahaba GBA)(Contract)
(Warren Averett Healthcare Division) - Birmingham, AL - January 2015 to December 2015
Processing new and established Medicare Part B provider applications, and ensuring that all providers given a number are in compliance with the CMS regulations. Assign and log all Medicare provider numbers in an accurate and timely manner. Approved, denied, or rejected applications based on the CMS guidelines. Maintains PECOS databases for all practitioners. Ensure that all information meets federal and state guidelines when processing applications. Enforce regulatory compliance and quality assurance. Determine the proper credentials needed for each type of provider. Secure all information and verify license with proper state agency if applicable. Complies with CMS and HIPAA guidelines and regulations. Answered Contact Center Calls. Verified enrollment status for providers. Revalidation project
Provider Enrollment Specialist- (WPS & NGS GBA’s)
(BroadPath Healthcare Solutions) - Tucson, AZ - May 2013 to January 2015 Processing new and established Medicare Part B provider applications, and ensuring that all providers given a number are in compliance with the CMS regulations. Assign and log all Medicare provider numbers in an accurate and timely manner. Approved, denied, or rejected applications based on the CMS guidelines. Maintains PECOS databases for all practitioners. Ensure that all information meets federal and state guidelines when processing applications. Enforce regulatory compliance and quality assurance. Determine the proper credentials needed for each type of provider. Secure all information and verify license with proper state agency if applicable. Complies with CMS and HIPAA guidelines and regulations. Answered Contact Center Calls. Verified enrollment status for providers. Revalidation project.
Pharmacy Technician
(CVS Pharmacy) - Decatur, GA - March 2010 – May 2013 Responsible for inputting prescriptions, as well as filling them. Ringing customers up for medications and other store merchandise. I am also responsible for solving insurance issues for customers, as well as assisting the pharmacist with whatever jobs they need. I also help keep track of inventory.
Medicare Discrepancy Analyst
(Healthcare Corporation of America) - Atlanta, GA - February 2007 to May 2010 Work Discrepancy Report to determine types of discrepancies and assign appropriate reason codes. Make all corrections of non-payment related discrepancies. Forwarded all other discrepancies to Overpayment or Underpayment Analyst. Practice and adhere to the
"Code of Conduct" philosophy and "Mission and Value Statement". Other duties as assigned. Responsible for logging all discrepancies and correcting non-payment related discrepancies. Communication - communicates clearly and concisely, verbally and in writing. Customer orientation- established and maintained long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations. Interpersonal skills - able to work effectively with other employees, patients and external parties .PC skills - demonstrated proficiency in Microsoft Office applications and others as required. Policies & Procedures - demonstrated knowledge and understanding of organizational policies, procedures and systems. Basic skills - able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately.
Financial Dispositions Specialist (Affiliated Computer SVC) Atlanta, GA - February 2005 to February 2007
Examined Georgia Medicaid claims to reconcile accounting variances between healthcare providers and the Georgia Department of Community Health(DCH) Transcribed, allocated and compiled financial transactions and events in accordance with mandated accounting principles. Managed applying and verifying knowledge of pertinent laws and regulations (HIPAA), in addition to leading internal audits in conjunction with government and private agencies
Financial Counselor/Pharmacy Technician II ( ADAP PHARM)
(Grady Memorial Health System) - Atlanta, GA - April 2000 to March 2004 Conducted comprehensive patient interviews to determine patients’ ability to pay for services. Identified /verified the possibility of third party coverage of patients while providing excellent customer service. Compiled and formatted reports reflecting Ryan White Grant funds. Resolved customer conflicts, identified discrepancies and provided resolutions. Handled routine data entry of prescriptions and refills as well as prepared medications for pharmacist to review.
Kaiser Permanente-Atlanta, GA 1994-2000
Responsible for inputting prescriptions, as well as filling them. Ringing customers up for medications and other store merchandise. I am also responsible for solving insurance issues for customers, as well as assisting the pharmacist with whatever jobs they need. I also help keep track of inventory. Worked different locations as needed. Accomplishments
I learned to process the different Medicare Applications for providers, assign PTAN numbers, Maintain different provider databases.
Skills Used
•Administrative support ICD-9
•Problem resolution ICD-10
•Provider Enrollment CPT-10
•Spreadsheet development 855R,855O, 855I, 855B
•Pecos Case 360
•Procert PIMS
•MCS PEGA
•Report Analyst OIG, SAMS
•Medisoft proficient Switch Board
•Filing and data archiving Multitasking
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