Angela N Pullins
Indianapolis
Summary
Dynamic Provider Relations Specialist with extensive experience at Mdwise/Repucare, excelling in provider enrollment and regulatory compliance. Proven ability to enhance workflow efficiency and maintain documentation accuracy. Skilled in data verification and active listening, fostering strong provider relationships while ensuring adherence to industry standards. Committed to delivering exceptional service and support.
Overview
16
16
years of professional experience
Work History
Providers Relations Specialist
Mdwise/Repucare
10.2022 - Current
- Processed provider enrolment and disenrollment for multiple providers.
- Ensured accurate documentation for entry into plans claims system.
- Maintained and updated provider directories to meet requirements.
- Supported all aspects of provider directory needs.
- Verified accuracy of provider demographics for compliance.
- Performed additional duties as required to enhance departmental efficiency.
- Managed provider enrollment processes to ensure compliance with regulatory guidelines.
- Reviewed applications for accuracy and completeness before submission to networks.
- Utilized enrollment management systems to track provider status and documentation.
- Assisted in resolving provider inquiries related to enrollment issues promptly.
- Developed training materials for new staff on enrollment procedures and policies.
- Maintained up-to-date knowledge of industry changes impacting provider enrollment practices.
- Responded to requests for information about enrollment process.
- Reviewed and updated provider enrollment applications to ensure accuracy and completeness of information.
- Performed verification checks for new provider enrollments in accordance with company policies and procedures.
- Processed re-enrollment requests for terminated providers who wish to be reinstated into the network.
- Evaluated incoming requests for exceptions or waivers from standard policy guidelines pertaining to provider enrolment criteria.
- Provided guidance to providers on the enrollment process, timelines, and requirements.
- Resolved discrepancies between provider applications and available data sources.
- Utilized effective active listening, interpersonal and communication skills in collaborating with different individuals on daily basis.
- Responded promptly to inquiries from providers regarding their status within the network.
- Maintained accurate records regarding all aspects of the enrollment process in a secure database.
- Monitored daily workflow activity related to provider enrollments and identified areas for improvement.
- Reconciled differences between submitted documentation and information received from providers against government databases.
- Collaborated with internal departments to ensure proper processing of enrollment applications.
- Assessed potential risks associated with proposed new enrollments prior making final decisions.
- Handled new enrollments by entering customers' data and reviewing information.
- Proofread documents carefully to check accuracy and completeness of all paperwork.
- Assisted with the enrollment process by explaining various policies and procedures to prospective students.
- Performed careful reviews of applicant data to ascertain compliance with eligibility criteria for economic assistance.
CSR-Contract Management
APS Medical Billing
Toledo
05.2021 - 09.2022
- Processed provider enrollment for several providers and insurances
- Adjusted accounts
- Outbound calls
- Appeals Grievance Procedures
- Prior authorization
- Insurance Verification
- Completed Reports
- Data Entry
- Contacted Providers
- Fee schedules
- Enrollment
- Benefit Investigation
- Reading contracts
- Provide direct client support
- Monitor the timeliness of charges, payments and insurance follow up to ensure contractual obligation set forth by the client is meet
- Toledo, Ohio
- Worked closely with providers, vendors, carriers, brokers. to ensure timely processing of enrollments.
- Coordinated communication between healthcare providers in multiple departments or locations.
- Answered inquiries from providers regarding claim status, payment issues.
- Researched complex cases involving multiple providers or policies.
Patient Account Representative
OBGYN of Indiana
Carnel
08.2015 - 04.2021
- Customer Service
- Ensure payments for all insurance plans and self pay patients
- Contacting insurance companies
- Inbound and Outbound calls
- Work claim denials, appeals, and corrected claims
- Collecting payments from insurance companies
- Appeals Grievance Procedures
- Prior authorization
- Insurance Verification
- Enrollment
- Benefit Investigation
- Patient collections
- Follow up on claims
- Managing incoming calls from patients some outgoing calls
- Providing EOB assistance for patients
- Revenue cycle, buy and bill
- Take payments from patients over the phone
- Verify insurance
- Some medical coding
- Provide medical records at patients or insurance request
- Carnel, IN
Utilization Management
Anthem/AppleOne
Indianapolis
03.2014 - 08.2015
- Managing incoming calls or Incoming post services claims work
- Determining contract and benefit eligibility
- Providing authorization for inpatient admission
- Outpatient precertification
- Prior authorization
- Indianapolis, IN
Commercial Collections
Fresenius Medical Care/Milliner & Associates
Indianapolis
06.2010 - 12.2013
- Collecting Payment
- Commercial Carriers
- Setting Payment Arrangements
- Post Payments Electronically check/credit
- Research Unpaid Claims
- Data Entry
- Customer Service
- Filed Claims
- Processed Reimbursements
- Collecting For Multiple Hospitals
- Clinics and Physicians
- Indianapolis, IN
Customer Service
Zotec Health Partners/Officeteam
Indianapolis
12.2009 - 03.2011
- Call center
- EOB’s
- Collecting Payments
- Post Payments Electronically
- Cash Posting, Refunds
- Collections, Medicare
- Medicaid
- Data Entry
- Coding, ICD-9, CPT, HCPCS
- Customer Service
- Filed Claims with Insurance Companies
- Quota Met Daily
- A/R, Collections for Multiple Hospitals and Clinics for over 20 states.
- Indianapolis, IN
Education
Associate Degree - Medical Terminology, Anatomy & Physiology, Medical Insurance CPT/HCPCS, ICD-9
Medtech College
Indianapolis, IN01.2008
Diploma -
Arsenal Technical Highschool
Indianapolis, IN01.1999
Skills
- Provider enrollment
- Claims processing
- Data verification
- Regulatory compliance
- Documentation accuracy
- Customer relationship management
- Enrollment systems management
- Workflow optimization
- Active listening
- Effective communication
- Problem solving
- Attention to detail
- Team collaboration
- Policy interpretation
- Provider relationship management
- Healthcare industry
- Multitasking Abilities
- Excellent communication
- Problem-solving
- Listening skills
- Multitasking
- Adaptability and flexibility
- Case management
- Problem-solving abilities
- Time management abilities
Timeline
Providers Relations Specialist
Mdwise/Repucare
10.2022 - Current
CSR-Contract Management
APS Medical Billing
05.2021 - 09.2022
Patient Account Representative
OBGYN of Indiana
08.2015 - 04.2021
Utilization Management
Anthem/AppleOne
03.2014 - 08.2015
Commercial Collections
Fresenius Medical Care/Milliner & Associates
06.2010 - 12.2013
Customer Service
Zotec Health Partners/Officeteam
12.2009 - 03.2011
Associate Degree - Medical Terminology, Anatomy & Physiology, Medical Insurance CPT/HCPCS, ICD-9
Medtech College
Diploma -
Arsenal Technical Highschool