Provider Enrollment/Credentialing Specialist

Worked at BPO companies as a Customer Support within the healthcare industry. Worked as a Market Researcher at BPO

Works as an Insight Analyst, previously as a Claims Specialist | Fraud Analyst -Responsible for reviewing claims end-to-end activities ensuring accuracy and completeness. Reviewing possible fraud, waste and abuse claims. - Identifying and Preventing payment of inappropriate or erroneous charges submitted by healthcare Providers. -Managing workloads to ensure that cases are handled appropriately and resolved in a timely manner. - Understands and resolves work ques which includes but are limited to: Approved/Denied claims, Appealed Claims, Duplicate, Timely Filing, License Issue, Medical Records Request, COB. Provide monthly feedback on clients and providers on issues identified at a system level and execute escalation procedures if applicable. Perform analysis to help identify trends and detect root cause deficiencies.

Responsible for managing the end-to-end credentialing and enrollment process for healthcare providers, ensuring compliance with federal, state, and payer-specific requirements. Help and supports accurate provider setup, maintenance, and validation across all relevant systems while maintaining high standards for quality, timeliness, and regulatory adherence.Manage provider enrollment and credentialing processes with commercial and government payers. Hands-on experience with CAQH ProView, including initial setup, quarterly re-attestations, and document management. Experience using Availity and commercial payer portals. Coordinate provider setup activities and ensure accurate provider information across systems. Monitor and follow up on payer applications, revalidations, and enrollment status updates. Support revenue cycle operations, including billing, collections, and denial management. Investigate and resolve payer enrollment and reimbursement issues. Maintain accurate documentation and records related to provider enrollment and credentialing. Collaborate with internal teams to ensure providers are properly configured and ready for billing. Assist with accounts receivable follow-up and revenue cycle projects as needed. Ensure compliance with payer requirements and healthcare regulations. Provide administrative and operational support to the revenue cycle team.

Content moderator - responsible for user-generated content submitted to an online platform. • Making sure that items are placed in the right category, are free from scams, doesn’t include any illegal items, and much more

Content moderator - responsible for user-generated content submitted to an online platform. • Making sure that items are placed in the right category, are free from scams, doesn’t include any illegal items, and much more