• Maintain Monthly Start Up Report of New Providers, Tracking Their Enrollments for Medicare, Medicaid, And BCBS. • Maintain the Shared Provider Enrollment Inbox, Forward Emails to the Appropriate Specialist to Work.• Maintain And Ensure All Provider's CAQH Profiles Up to Date and Re-Attested Every 120 Days.• Verify All Licenses and Certificates Are Current and Update.• Responsible For Adding New Locations in The Care System.• Responsible For Checking and Resolving the Following Athena Correspondence Mailboxes in Each Tablespace, At Least Once A Month: Payer Correspondence: No Action If Not Applicable to Enrollment: Provider Number Confirmation/ Information: Send to Appropriate Specialist.

• Responsible for Full Reconciliation of Provider’s record in QNXT, OLPD and HSD• Responsible for Entering Provider Data in OLPD• Responsible for Entering Provider Data in HSD• Responsible for Submitting PCMA Requests to PDM• Responsible for Ensuring Quality of Data entered in Online Provider Directory• Responsible for Adhering to guidelines set by Medicare and Medicaid Services• Responsible for working independently and as a team player• Responsible for utilizing analytical and Creative Thinking Skills• Responsible for Growth and Development within the Provider Data Validation Team

• Responsible for Maintaining Provider Data In QNXT• Responsible for Entering Provider Data In QNXT• Responsible for Ensuring Quality Of Data Entered In QNXT• Responsible for Enrollment of Providers In QNXT• Responsible for Provider Updates, Corrections In QNXT

• Review and Analyze Life Insurance Applications for completeness• Identify Inaccuracies and Missing information• Contact Insurance Agents for Missing Information and for Verification of Questionable Information Provided on Application• Update Data Once Verified• Prepare Documents and Requested Information for Mailing• Assemble and Collate Insurance Packets

• Ensures the delivery of excellent customer service through fast and accurate processing of requests, communication, and coordination with other departments to resolve inquires.• First point of customer contact for general inquiries such as pricing, products, customer complaints, etc.• Maintain extremely high levels of customer security and privacy.• Perform data entry by using computer specific software programs.

• Processed release of information (ROI) specifically medicalrecord requests in a timely and efficient manner ensuring accuracy and providing customers with the highest quality product and customer service• safeguard and protect the patient’s right to privacy by ensuring that only authorized individuals have access to the patient’s medical information and that all releases of information are in compliance with the request, authorization, company policy and HIPAA regulations.• Data Entry• Ten Key• Alpha Numeric

• Maintained Provider Database for Physicians • Batch Incoming Requests into Cigna Systems• Complete the Review Process using Cigna's Policy and Procedure Guidelines • Update Cigna's System according the Provider's Request - Addition, Demographic Updates and Termination• Build and Establish Relationship with Internal and External Matrix Partners• Research problems and negotiates with internal/external partners/customers to resolve highly complex and/or escalated and sensitive issues• Manage appropriate physician correspondence• Scheduled and Facilitated Team Meeting• Morale Leader for Department - developed ideas and events to increase the team's morale • Data Entry• General Office duties Faxing, Copying, Processing Mail, Scanning Documents, Filing, Email Correspondence, Typing, Answering Phones• Problem Solving• Provided Status RequestsAccomplishments:• Identified and Resolved Issues causing Claims to be paid incorrectly• Worked as a Team Player to Reduce Inventory• Established Positive Relationships with Internal and External Matrix Partners