Provider Enrollment & Customer Service Specialist
Resume:
ALICYAN
JONES
Provider Enrollment Specialist
*******@*****.***
Phoenix, AZ 85041
SKILLS
Database Management
Salesforce
Adaptable
CPT Coding
ICD-9 & ICD-10
Medical Claims Processing
Medical Terminology
EHR/EMR Systems
Typing (50+ WPM)
10-Key (14,500+ KSPH)
Benefits Verification
Project Management
Technical Skills
Customer & Provider Services
Interpersonal Skills
EDUCATION
Gateway Community College
Online • Expected in 04/2027
Associate of Applied Science: Healthcare Regulatory Compliance
Kaplan College
Dallas, TX • Graduated 09/2010
Medical Office Management Diploma
PROFESSIONAL SUMMARY
Self-motivated Customer Service & Data Entry Professional with 15+ years' experience across Healthcare & Customer Service fields. Consistently demonstrating the ability to work well in highly stressful & ever-changing environments, exceed expectations & handles Customer & Provider concerns efficiently & effectively. A leader & team motivator with Supervisor experience, with strong data entry, communication skills & positive attitude, who excels working independently and in collaborative initiatives.
WORK HISTORY
Cigna HCSC– Provider Enrollment Specialist (Contract) Remote 07/2025 – Current
•Completed and submitted initial, revalidation and updated Provider enrollment applications for Medicare, Medicaid and Commercial payers
•Maintained accurate provider, group and location records across payer portals and internal enrollment databases
•Tracked enrollment applications from submission
through approval using internal tracking tools to ensure timely processing
•Followed up with payers to obtain status updates and resolve pending or incomplete enrollment issues
•Obtained, verified and validated required enrollment documentation.
Virtix Health – Medical Records Specialist (Contract) Remote 02/2025 – 05/2025
•Coordinated high-volume outbound provider outreach via phone, fax and mail to retrieve missing medical records for HEDIS and compliance audits
•Entered, tracked and validated documentation across multiple systems to ensure audit readiness and regulatory compliance
•Researched incomplete or missing records and followed up with providers to resolve documentation gaps within required timelines.
DEVOTED HEALTH - Member Services Guide I
Remote • 10/2023 – 11/2024
Explained benefit structures for Small & Large Groups, Individual & Medicare Health policies.
Assisted Members variety of customer service issues regarding claims, benefits, eligibility, provider relations, billing & payments.
Performed Tier 1 Technical requests for members.
Assisted Member with Provider and facility changes.
Managed internal & external requests for Medical Records, verified procedure authorizations & referrals.
PANORAMIC HEALTH - Credentialing Coordinator
Remote • 04/2022 – 08/2023
Managing & monitoring enrollments for minimum of 87 permanent Providers over 5 states; including updates, re-credentialing needs & terminations of existing providers ensuring all rules, regulations & documentation requirements are met.
Completing provider credentialing & re-credentialing applications; monitoring applications & follows-up, as needed.
Maintaining LexisNexis, CAQH and other databases, updating accordingly with information regarding employee training, licenses, education, continuing education, & relevant job experience.
Conducting full cycle credentialing process for new & existing providers, ensuring all are credentialed with appropriate health plans for their practice location.
KAISER PERMANENTE GA - Member Service/Provider Services Rep
Duluth, GA (Remote) • 09/2014 - 10/2019
Resolved variety of customer service issues regarding quality assurance, benefits, eligibility, provider relations, billing & payments.
Assisted Members & Providers with Appointment Scheduling; claims status, details & reprocessing; Explained benefit structures for Small & Large Groups, Individual & Medicare Health policies.
Managed internal & external requests for Medical Records.
Verified procedure authorizations, referrals, & appointments.
Assisted Members with filing disputes, dispute resolutions & complaints; Investigated & resolved customer inquiries & complaints quickly.
Responsible for payment arrangement set up & collection of Payments for fees & services through POS system.
Worked as central liaison for disadvantaged members & SME on GA State assistance programs.
Responded proactively & positively to rapid change & company growth.
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