Yatisha Jones
Wilson
Summary
Experienced with managing provider enrollment processes, ensuring timely and accurate credentialing. Utilizes strong communication and organizational skills to enhance workflow efficiency. Knowledge of compliance regulations and documentation management ensures seamless operations.
Overview
10
10
years of professional experience
Work History
Provider Enrollment Specialist II
GDIT
05.2024 - Current
- Process provider enrollment applications to ensure new and currently enrolled providers are within compliance within NC State regulations.
- Validate the qualifications of licensed professionals, organizational members or organizations
- Render a determination that an organization or entity meets the established qualifications, requirements and/or standards to provide a service or procedure as outlined in the State business rules/desk procedures.
- Perform and assess the background check through Lexis Nexis, AAR and PPTD.
- Perform source verification of licensure, certification, endorsements and accreditations through Lexis Nexis or State Licensure Board.
- Meet performance quantity and quality standards on a daily basis.
Provider Enrollment Specialist
IT Resource Solutions
05.2023 - 05.2024
- 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.
- Resolved discrepancies between provider applications and available data sources.
- Handled new enrollments by entering customers' data and reviewing information.
- Granted, modified, denied, or terminated assistance based on key information and eligibility determination.
Patient Care Specialist
Boice-Willis Clinic
08.2022 - 03.2023
- Updated patient charts while maintaining client confidentiality with eClincal Works.
- Verified demographics and insurance information to register patients in computer system.
- Obtained necessary signatures for privacy laws and consent for treatment.
- Communicated financial obligations to patients and collected fees at time of service.
- Reviewed referral details and expectations with providers and patients and requested new referrals when necessary.
- Reviewed data obtained from referring physicians for completeness and accuracy.
- Tracked referral request progress and resolved issues to maintain smooth processing.
- Contacted patients to confirm or reschedule appointments to minimize no-show appointments.
- Prioritized referrals according to urgency and adhered to appropriate referral deadlines.
Medical Office Assistant
Carolina Gastroenterology
01.2022 - 07.2022
- Registered patients and scheduled appointments.
- Assisted with referrals and prepared medical records for patients.
- Educated patients about medications, procedures and physician's instructions.
- Collected information, verified insurance and collected co-payments for patients as part of check-in process.
- Managed incoming telephone calls, took messages and directed callers to personnel.
- Communicated with patients to resolve inquiries, schedule appointments and address billing questions.
Customer Service Representative
CVScaremark
09.2021 - 12.2021
- De-escalated problematic customer concerns, maintaining calm, friendly demeanor.
- Educated customers on special pricing opportunities and company offerings.
- Upheld quality control policies and procedures to increase customer satisfaction.
- Asked probing questions to determine service needs and accurately input information into electronic systems.
- Explained benefits, features and recommendations to maximize client retention.
Patient Access Representative
Vidant HealthPlex-Wilson
10.2018 - 08.2021
- Scheduled and confirmed patient appointments with patients and healthcare professionals.
- Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
- Scheduled patient appointment and procedures with EPIC.
- Attended departmental meetings, providing feedback to enhance future performance.
- Verified demographics and insurance information to register patients in computer system.
- Processed patient responsibility estimate determined by insurance at pre-registration.
Front Office Associate
Carolina Family Health Centers Inc.
11.2015 - 10.2018
- Greet and check-in/check-out patients.
- Organized, updated and maintain over 200 patients charts.
- Collect co-payment and verify insurance coverage.
- Schedule and confirm patient appointments.
- Perform clerical duties, such as word processing, data entry and answering phones.
Education
Some College (No Degree) - Elementary Education
Fayetteville State University
Fayetteville, NCHigh School Diploma -
Charles B Aycock High School
Pikeville, NC06.2010
Skills
- Team Management
- Regulatory compliance
- HIPAA compliance awareness
- Continuous learning attitude
- Data entry proficiency
- Credentialing
- Insurance verification experience
- Strong understanding of NC Medicaid or other healthcare programs
- Familiarity with NCTracks and provider enrollment guidelines
- Proficiency with Microsoft Office Suite including Word, Excel, and Outlook
Timeline
Provider Enrollment Specialist II
GDIT
05.2024 - Current
Provider Enrollment Specialist
IT Resource Solutions
05.2023 - 05.2024
Patient Care Specialist
Boice-Willis Clinic
08.2022 - 03.2023
Medical Office Assistant
Carolina Gastroenterology
01.2022 - 07.2022
Customer Service Representative
CVScaremark
09.2021 - 12.2021
Patient Access Representative
Vidant HealthPlex-Wilson
10.2018 - 08.2021
Front Office Associate
Carolina Family Health Centers Inc.
11.2015 - 10.2018
High School Diploma -
Charles B Aycock High School
Some College (No Degree) - Elementary Education
Fayetteville State University
References
- Ashley Keller, NP: Vidant Healthplex/ Telephone: (602) 818-4781
- Chiquita Rodgers: Former Coworker/ Vidant Healthplex/ Telephone: (252) 217-9644
- Rayven Anderson: Former Coworker/ Vidant Healthplex/ Telephone: (252) 230-0259
- April Crocker: Former Coworker/ Carolina Gastroenterology/ Telephone: (252) 373-9823
Education and Training
other,other
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