Provider Enrollment Specialist - HIPAA-Compliant
Resume:
Ikeisha Faye Stewart
**** *. ******** **., *********, TX 76010 • 469-***-**** • **************@*****.*** 2112 E. Mitchell St., Arlington, TX 76010 • 469-***-**** • **************@*****.*** PROFESSIONAL SUMMARY
Detail-oriented Provider Enrollment Specialist with over 3 years of experience supporting provider and patient enrollment, credentialing, and insurance processing for commercial and government payers. Proven ability to manage high-volume call environments (120+ calls/day) while maintaining strict HIPAA and CMS compliance. Strong communicator with excellent documentation, data accuracy, and cross-functional collaboration skills. Experienced in fast-paced healthcare settings with a focus on quality, turnaround time, and provider satisfaction. CORE SKILLS
Provider Enrollment & Credentialing
Insurance Applications & Revalidations
Medicare, Medicaid & Commercial Payers
HIPAA & CMS Compliance
High-Volume Call Handling (Inbound/Outbound)
Enrollment Discrepancy Resolution
Patient & Provider Onboarding
Insurance Eligibility & Benefits Verification
Claims Support & Documentation
Data Entry & Record Management
Conflict Resolution & Customer Support
Microsoft Office Suite (Word, Excel, PowerPoint)
Typing Speed: 3,000 Keystrokes/Minute
PROFESSIONAL EXPERIENCE
CCS Medical
– Irving, TX
Provider Enrollment Specialist June 2023 – March 2025 Managed 120–130 inbound and outbound calls daily, assisting providers and patients with insurance enrollment, eligibility, and application status.
Processed provider enrollment applications and revalidations for commercial and government payers, ensuring accuracy and compliance.
Conducted patient onboarding by collecting required documentation and consents while maintaining HIPAA and CMS standards.
Entered, reviewed, and updated provider and patient data in internal systems with a high level of accuracy.
Identified and resolved enrollment discrepancies by coordinating with internal departments, insurance carriers, and external providers.
Verified insurance eligibility and benefits to reduce claim denials and support timely reimbursement. Maintained detailed call logs, documentation, and system notes to support audits and quality assurance reviews.
Collaborated with billing, credentialing, and compliance teams to improve enrollment turnaround time and workflow efficiency.
Educated providers and patients on enrollment requirements, coverage policies, and next steps. McKesson Health
– Irving, TX
Provider Enrollment Specialist November 2021 – March 2023 Handled 100–110 inbound and outbound calls daily, supporting providers and patients with enrollment, claims status, and eligibility inquiries.
Processed initial provider enrollments and re-credentialing for Medicare, Medicaid, and commercial payers.
Maintained and updated provider and patient records, ensuring compliance with payer guidelines and regulatory requirements.
Investigated and resolved enrollment and credentialing discrepancies by working directly with insurance carriers and internal teams.
Supported claims processing by tracking submissions and reimbursements and ensuring accurate documentation.
Managed enrollment documentation including provider agreements, W-9s, and direct deposit forms. Ensured audit readiness through thorough documentation of all communications and actions taken. Partnered with cross-functional teams to improve workflow efficiency and provider satisfaction. EDUCATION
High School Diploma
St. Augustine Catholic High School – Fort Worth, TX ADDITIONAL INFORMATION
Comfortable working remotely
Able to work standard business hours (8:00 AM – 5:00 PM) and overtime as needed No planned time off during the first six months of employment
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